ririРаны и раневые инфекции. Журнал имени проф. Б.М. КостючёнкаWounds and wound infections. The prof. B.M. Kostyuchenok journal2408-96132500-0594Regional non-governmental organization “Surgical society - Wounds and wound infections”10.25199/2408-9613-2018-6-1-13-24riri-168Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL REPORTSПяточно-большеберцовый артродез в хирургической тактике лечения стопы Шарко с поражением голеностопного суставаTibiocalcameal arthrodesis as a surgical option for Charcot ankle deformityОболенскийВ. Н.ObolenskiyV. N.

Владимир Николаевич Оболенский

115280, Москва, ул. Велозаводская, д. 1/1, 

117997, Москва, ул. Островитянова, д. 1

 

1/1 Velozavodskaya Str., Moscow, 115280, 

1 Ostrovityanova Str., Moscow, 117997

gkb13@mail.ruПроцкоВ. Г.ProtskoV. G.

115446, Москва, Коломенский проезд, д. 4, 

117198, Москва, ул. Миклухо-Маклая, д. 8

4 Kolomenskiy P., Moscow, 115446, 

8 Miklukho-Maklaya Str., Moscow, 117198

ГБУЗ «Городская клиническая больница № 13 ДЗМ»; ГБОУ ВПО «Российский национальный исследовательский медицинский университет им. Н. И. Пирогова» Минздрава РоссииРоссияSBHI “City clinical hospital 13 MCHD”; Pirogov Russian National Research Medical UniversityRussian FederationГБУЗ «Городская клиническая больница им. С. С. Юдина ДЗМ»; ФГАОУ ВО «Российский университет дружбы народов» Минобрнауки РоссииРоссияSBHI “S. S. Yudin City clinical hospital MCHD”; FSGAO of HE “Peoples’ Friendship University of Russia” Ministry of Education and Science of RussiaRussian Federation201907052019611324Copyright © Оболенский В.Н., Процко В.Г., 20192019Оболенский В.Н., Процко В.Г.Obolenskiy V.N., Protsko V.G.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.riri.su/jour/article/view/168Цель исследования

Цель исследования: оценить эффективность и безопасность различных видов пяточно-большеберцового артродеза в лечении пациентов со стопой Шарко на фоне сахарного диабета с поражением голеностопного сустава в зависимости от распространенности и стадии патологического процесса.

Материалы и методы исследования. Проведен анализ результатов лечения 16 пациентов с синдромом диабетической стопы с остеоартропатией (стопа Шарко) в стадии гнойных осложнений с локализацией патологического процесса в костях, составляющих голеностопный и подтаранный суставы: 8 пациентам был выполнен пяточно-большеберцовый артродез с фиксацией в аппарате наружной фиксации и 8 больным – с внутренней фиксацией канюлированными винтами. Период послеоперационного наблюдения составил более 1 [1–3] года.

Результаты исследования

Результаты исследования. В ранние сроки (до 1 месяца с момента операции) осложнений выявлено не было. Осложнения в более поздние сроки развились у 4 (25,0 %) больных: у 3 (37,5 %) с внутренней фиксацией и у 1 (12,5 %) – с внешней.

Заключение

Заключение. На наш взгляд, при выборе тактики фиксации стопы при пяточно-большеберцовом артродезе группами риска следует считать стадию D по классификации Rogers и стадию 3 по классификации Wagner. После резекции костей у таких больных предпочтительнее внешняя фиксация. В остальных стадиях целесообразна внутренняя фиксация, так как при ней отмечается более высокое качество жизни пациентов и сокращаются сроки реабилитации.

Object

Object. To assess the effectivity and safety of different tibiocalcaneal arthrodesis types in treatment of patients with Charcot ankle deformity depending on disease severity.

Materials and methods

Materials and methods. We have analyzed the outcomes after treatment of 16 patients with diabetic neuropathic ankle arthropathy (Charcot ankle) at the stage of septic complications in bones of ankle and subtalar joints. The observation period was more than 1 [1–3] year. Ilizarov fixator for TCA was used in 8 cases; internal fixation with cannulated screws was applied in 8 cases.

Results

Results. In the early periods (up to 1 month from the operation) no complications were revealed. Complications in later terms developed in 4 patients: three with internal fixation and one with external.

Conclusion

Conclusion. In our opinion, when choosing foot fixation tactics for heel-tibial arthrodesis, risk groups should be considered stage D according to Rogers classification and stage 3 according to Wagner classification, and after resection of bones in these patients external fixation is preferable. In the remaining stages, internal fixation is advisable because of the patient's higher quality of life and shortening of the rehabilitation period.

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The authors declare that there are no conflicts of interest present.