RU2624230C1 - Method for treatment of patients with acute stage of diabetic neurosteoartropathy of charcot foot type - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to treatment of the acute stage of diabetic neuro-osteoarthropathy ("Charcot foot"). To do this, the affected limb is unloaded and 2.0 to 4.0 ml of platelet-enriched autoplasma is injected into the area of aseptic inflammation and osteodestruction. The number of procedures is from 1 to 3 per a course of treatment of up to 2-3 weeks.

EFFECT: method prevents the development of destruction of the foot osteoarticular apparatus, deformation and plantar ulcer defects formation.

1 ex

Description

The invention relates to medicine, in particular to traumatology and orthopedics, and is intended for the treatment of patients with diabetic neuroosteoarthropathy of the type of "Charcot's foot."

Diabetic neuroosteoarthropathy or Charcot's foot is a serious complication of diabetes. It is characterized by bone changes, such as osteoporosis (when the bones become thinner and less durable), osteolysis (complete resorption of bone tissue), hyperostosis (proliferation of the cortical layer of the bone). Sharko's foot manifests itself in the form of numerous fractures of the bones of the foot, in their incorrect fusion and, as a result, deformation of the foot. In the acute stage of Charcot's foot, bone fractures occur, while the feet become inflamed, the foot becomes hot. The patient's body temperature rises to 38-39 degrees, intoxication symptoms appear, but there are no pains in the limb due to diabetic polyneuropathy, so the patient does not know about fractures. The patient continues to walk and step on the sore limb, which provokes further fractures and deformation of the foot.

As a prototype, a method was selected that included examining a patient with subsequent unloading of the affected limb with circular plaster casts for 4-6 months (see G.R. Galstyan et al. Clinical recommendations for the diagnosis and treatment of diabetic foot syndrome // Wounds and wound infections, 2015, No. 3, pp. 63-83).

However, prolonged immobilization does not make it possible to stop aseptic inflammation, reduce the severity of intoxication, and reduce pain in the foot. In addition, it enhances the factors of destruction of the foot bones (osteoporosis, osteolysis).

The task of the invention is to improve the method.

EFFECT: prevention of the development of destruction of the osteoarticular apparatus of the foot, deformation and formation of plantar ulcerative defects.

The technical result is achieved due to the fact that in the method, which includes examining the patient and unloading the affected limb into the area of developed aseptic inflammation and osteodestruction, an injection of platelet-rich autoplasma from 2.0 to 4.0 ml per one anatomical formation from 1 to 3 autografts is performed for a course of treatment up to 2-3 weeks.

The proposed method for the treatment of patients with acute stage of diabetic neuroosteoarthropathy of the type of "Charcot's foot" is as follows. In the conditions of a surgical hospital, the maximum unloading of the affected limb is prescribed by using bed rest with an elevated position of the limb, and for moving, use crutches without loading the foot. To determine the activity of aseptic inflammation on the foot, a blood test is performed (hemoglobin, red blood cells, white blood cells, ESR), CRP protein, preseptin, procalcitonin. To determine the extent of the spread of lytic destruction of the osteoarticular apparatus of the foot, a radiography of the foot is performed, and in the presence of fistulous passages, fistulography of the foot is performed. After examining the patient in the operating room, venous blood is sampled, from which autoplasma enriched with platelets is prepared. Not later than 5-7 minutes from the time of its manufacture, the patient is injected with a platelet-rich autoplasma from 2.0 to 4.0 ml per one anatomical formation (Lysfranc joint, Shopar joint, subtalar or ankle joints) in the area of developed aseptic inflammation and osteodestruction. The number of procedures depends on the intensity of reducing the activity of aseptic inflammation on the foot - from 1 to 3 autotransplants of platelet-rich plasma for a course of inpatient treatment for up to 2-3 weeks.

Clinical example. Patient L., 46 years old, was admitted to the purulent surgery department of the FSBI “PFMIC” of the Ministry of Health of Russia with a diagnosis of diabetes mellitus (type II), severe, decompensated. Neuropathic form of the syndrome "Diabetic foot". The acute stage of diabetic neuroosteoarthropathy of the left foot with destruction of the Lisfranc and Shopar joints, subluxation of the foot into the outer and plantar surfaces at the level of the Lisfranc joint. Diabetic peripheral polyneuropathy. Diabetic angioretinopathy, anigonephropathy, Art. microalbuminuria. CRF 0 tbsp.

Upon admission, body temperature is from 38.6-38.8-40.8 to 37.4 ° C. According to the analyzes: active current inflammation: preseptin = 664 pg / ml, procalcitonin ≥ 2 ng / ml, c-reactive protein 208 mg / l, erythritol = 3.06 million .; hemoglob = 84 g / l; hematocrit = 27.1%; ESR 61 mm / h. Sowing blood for sterility - no microflora growth. X-ray examination: sphenoid bones with signs of ongoing destruction. In the marked zone, sequestration-like, lysed shadows are traced. Uneven destructive changes at the level of the bases of the II-III-IV-V metatarsal bones, as well as the conjugate departments of the tarsal bones (talus, scaphoid, cuboid). There are distinct signs of subluxation of the foot in the outer and plantar sides at the level of the Lisfranc joint.

Assigned to bed rest, the elevated position of the limb on the Beller tire, immobilization of the limb with the rear plaster cast. To stop the inflammation, an injection of plasma enriched with platelets in an amount of 2.0 ml was performed in the area of the Lisfranc joint. The gypsum splint is replaced by a circular gypsum dressing, it is allowed to walk on crutches without loading the foot. The patient was discharged from the hospital for outpatient treatment.

At the follow-up examination in the clinic after 1.5 months, the inflammation was stopped, the current process of consolidation in the area of the Lisfranc joint was actively observed radiologically.

The method of treating patients with the acute stage of diabetic neuroosteoarthropathy of the “Charcot's foot” type is simple in terms of execution technique, safe, easy to learn, pathogenetically substantiated, and highly effective. Platelet-rich autoplasma contains platelet-derived growth factor (PDGF), angiogenesis factor (PDAF), transforming growth factor β (TGFb), insulin-like growth factor (IGF), endothelial cell growth factor (PD-ECGF). In the process of degranulation, platelets release a large number of biologically active substances: serotonin, catecholamines, adenosine diphosphate; fibrinogen, fibronectin, adenosine triphosphate, factor V, factor 8 (von Willebrand), thromboxane A2, calcium. All these factors have a high local activity and attract undifferentiated cells to the damage area (macrophages, mesenchymal stem cells, osteoblasts) and trigger the mitosis of these cells. The more growth factors are delivered to the wound site, the greater the healing potential. In this case, the processes of stopping aseptic inflammation, regeneration and mineralization of bone tissue in the focus of osteodestruction in the acute stage of diabetic neuroosteoarthropathy are activated.

Claims (1)

A method of treating patients with the acute stage of diabetic neuroosteoarthropathy of the “Charcot's foot” type, comprising examining the patient and unloading the affected limb, characterized in that transdermal injection of freshly prepared platelet-rich autoplasma from 2.0 to 4.0 ml is performed in the area of developed aseptic inflammation and osteodestruction for one anatomical formation from 1 to 3 autotransplants per hospital course up to 2-3 weeks.