Особенности специализированной помощи пациентам с диабетической остеоартропатией

Objective: to evaluate the results of specialized treatment of uncomplicated and complicated trophic ulcer (TU) and osteomyelitis (OM) of diabetic osteoarthropathy (DOAP). Materials and methods . The results of treatment in 114 patients (127 feet) with DOAP were analyzed: There were 52 (45.6 %) men, 62 (54.4 %) women. The type 1 diabetes mellitus (DM) was diagnosed in 36 (31.6 %) patients (average age 43.0 years old); type 2 diabetes – in 78 (68.4 %) people (average age – 58.0 years old). The acute and subacute stages of DOAP were detected in 55.9 % of cases, chronic – in 44.1 % of cases. The defeat of the middle part of the foot prevailed in 66.9 % of cases. Patients are ranked by the University of Texas classification. DOAP without TU – 71 (55.9 %) cases, with TU – 56 (44.1 %) observations. Stage BIII (OM) – 22 (17.3 %) cases: 8 (6.2 %) – in the subacute stage of DOAP, 14 (11.2 %) – in the chronic stage of DOAP. The examination protocol for DOAP included clinical data (+ sounding of the adjacent bone in TU), thermometry, radiography, and magnetic resonance imaging (MRI) of the feet, as well as laboratory data. A diagnostic algorithm has been developed for the optimal choice of tactical decisions in case of DOAP (TU–/OM–) and DOAP (TU+/OM+). Results . 80 patients were treated on an outpatient basis under the supervision of a podiatrist. Patients with acute or subacute DOAP (TU−/OM−) received conservative treatment in the form of unloading the limb using an individual discharge bandage until the transition to the chronic stage. In the chronic stage of DOAP (TU–/OM–) recommended the manufacture of complex orthopedic shoes for an individual block. In addition to the correction of hyperglycemia, patients with DOAP (TU+) (AI, AII, BI) used local treatment in accordance with the stage of the wound process. 34 patients (BII, BIII) were treated in a hospital. 27 patients of these underwent surgical procedures, osteonecrectomy, 7 patients underwent arthrodesis. All patients with DOAP (TU–/OM–) (n = 71) limb saved. With DOAP (TU+/OM+) (n = 56): 8 (14.3 %) people – the result is unknown, 7 (12.5 %) patients – retention of TU, 35 (62.5 %) patients – complete epithelization, 2 (3.6 %) cases – small amputations, 4 (7.2 %) – high amputations. Conclusion . Differentiated specialized treatment of uncomplicated and complicated by trophic ulcers or osteomyelitis DOAP in its various clinical stages made it possible to avoid high amputation in 96.6 % of cases.