Long-term results of corrective surgical interventions in patients with diabetic midfoot neuroosteoarthropathy

IF 0.7 Q4 ENDOCRINOLOGY & METABOLISM
Diabetes Mellitus Pub Date : 2023-09-25 DOI:10.14341/dm13000
M. M. Kalandiya, L. P. Doronina, V. A. Mitish, A. Yu. Tokmakova, E. L. Zaitseva, G. R. Galstyan
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Abstract

BACKGROUND : Diabetic neuroosteoarthropathy is a disabling complication of diabetes mellitus that develops as a result of impaired peripheral innervation and characterized by damage to bones and joints of non-infectious origin. As a result of pathological bone fractures, gross deformities of the foot are formed, which entails development of chronic ulcerative defects in areas of excessive load pressure. Currently, a number of surgical interventions are used to correct deformities, such as resection of bone structures, correction with metal structures and external fixation devices, but there is practically no data on their long-term results in the domestic literature. AIM : To study the results of orthopedic corrective interventions in patients with diabetes mellitus and midfoot neuroosteoarthropathy. MATERIALS AND METHODS : An analysis was made the data collected by questionnaire method of 55 patients operated in the diabetic foot department in the Endocrinology research centre from 2009-2019. All patients underwent a reconstructive operation aimed correcting a gross deformity of the midfoot. In postoperative period, the affected limb was off-loaded by total contact cast for a period of 3-6 months, and in the future, complex orthopedic shoes for permanent use and regular podiatric care were recommended to patients. RESULTS : After the first surgical intervention, 16 patients developed a recurrence of deformity, which required a second surgical intervention. The median period between interventions was 3 years. Chronic wounds of various localization of the operated foot were found in 25 patients. The median period between surgery and ulcer formation was 5 years. 9 patients with chronic wounds underwent minor amputations at the same foot. Amputations on the contralateral limb were performed in 7 patients. None of the patients underwent major amputations. CONCLUSION : Charcot foot is a severe complication of diabetes mellitus that can lead to loss of a lower limb. Due to results of the research orthopedic corrections of the midfoot deformities in patients with DNOAP can reduce the risk of ulcer developement and possible major amputations. Active monitoring and adequate orthopedic care in the postoperative period significantly reduce the risk of deformity recurrence and the need for repeated surgical interventions.
糖尿病足中部神经骨关节病患者矫正手术治疗的远期效果
背景:糖尿病神经骨关节病是糖尿病的致残性并发症,是周围神经支配受损的结果,以非感染性骨和关节损伤为特征。作为病理性骨折的结果,足部的严重畸形形成,这需要发展的慢性溃疡性缺陷的区域过度负荷压力。目前,许多外科干预措施被用于矫正畸形,如骨结构切除、金属结构矫正和外固定装置,但在国内文献中几乎没有关于其长期效果的数据。目的:探讨糖尿病合并足中神经骨关节病的矫形干预效果。材料与方法:对2009-2019年内分泌研究中心糖尿病足科55例患者的数据进行问卷调查分析。所有患者都进行了重建手术,旨在纠正足中部的严重畸形。术后3-6个月采用全接触铸型卸除患肢,今后建议患者长期使用复杂矫形鞋,定期进行足部护理。结果:第一次手术干预后,16例患者出现畸形复发,需要第二次手术干预。干预之间的中位间隔为3年。25例患者发现手术足部不同部位的慢性伤口。从手术到溃疡形成的中位时间为5年。9例慢性创伤患者同足行小截肢。对侧肢体截肢7例。所有患者均未进行大面积截肢。结论:沙氏足是糖尿病的一种严重并发症,可导致下肢丧失。根据研究结果,对DNOAP患者的足中畸形进行骨科矫正可以降低溃疡发展和可能的主要截肢的风险。术后积极监测和适当的骨科护理可显著降低畸形复发的风险和重复手术干预的需要。
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来源期刊
Diabetes Mellitus
Diabetes Mellitus ENDOCRINOLOGY & METABOLISM-
CiteScore
1.90
自引率
40.00%
发文量
61
审稿时长
7 weeks
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