Збереження опороздатності у хворих із глибокими трофічними розладами нижньої кінцівки

Динаміка змін внутрішньокісткового та підфасціального тиску у хворих з глибокими трофічними розладами нижньої кінцівки під впливом підшкірної фасціотомії гомілки. Показання до підшкірної фасціотомії гомілки та методика оперативного лікування хворих.

Рубрика Медицина
Вид автореферат
Язык украинский
Дата добавления 30.08.2014
Размер файла 48,5 K

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ANNOTATION

Artemenko V.O. Weight bearing ability preservation at patients with deep trophic disorders of lower-extremity. - Manuscript.

Thesis for the candidate of medical science degree at the specialty 14.01.21. - traumatology and orthopedics. Institute of traumatology and orthopedics of AMS of Ukraine, Kiev, 2007.

This thesis is dedicated to the topical subject. It is a medical treatment of the patients having deep trophic disorders (DTD) of lower-extremity. The treatment is aimed at preserving the support ability of the foot. According to the results of medicostatistic research it was discovered that DTD cause amputation of the inferior limb in 94% of the incidents. Along with this, there is an inadequacy between the ischemic affection degree of the limb and the amputation level. The clinic part of the thesis is based upon the treatment results of 86 patients having DTD of the lower-extremity owing to micro- and macroangiopathies (the obliteration atherosclerosis and endarteritis, diabetic angiopathy, Raynaud's disease) and necrotic suppurative process in the foot. These patients have experienced the system of surgical treatment including subcutaneous fasciothomy and advanced forefoot amputation system.

On the basis of ultrasonic examination and taking the intraosseous and subfascial pressure there have been elaborated indications for the culf subcutaneous fasciothomy and defined possible influences upon the trophism of the limb. It has been proved that the patients having neuropathic form of diabetic foot experience effective facsiotomy.

On the grounds of biochemical analysis the positive influence of culf subcutaneous fasciothomy on the trophism of the inferior limb has been proved. The same has been confirmed by activity increase of creatine phosphokinase and lactate dehydrogenase in the muscles after the operation. It has been also grounded for the adequacy of the foot's muscles ablation and for the revision of the rear deep tube of the leg under the amputation of the front part of the foot.

Surgical treatment tactics has been elaborated for the patients having DTD of the lower-extremity. This tactics is based on the surgical infection site and expansion, on defining the limb's arterial insufficiency (ischemia) rates as well as the characters of necrotic affection. Thanks to this tactics 71% of clinical patients saved the support ability of their lower-extremity.

Key words: a lower-extremity, weight bearing ability, deep trophic disorders, amputation.

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