UA20800U - A. liabakh method for assessing state of soft tissues of lower limb - Google Patents

Abstract

The method for assessing the state of the soft tissues of the lower limb provides for the measurement of the thickness of the soft tissues of the limbperformed by sonography. The thickness of the soft tissues of the support surface of the heel is measured with and without the load followed by the calculation of the elasticity coefficient.

Description

Description of the invention

The useful model refers to the field of medicine, in particular, it can be used to detect the presence of 2 trophic disorders of the lower limb.

It is known that systemic or local trophic disorders lead to tissue changes that first atrophy and then are replaced by scar tissue or necrotize |1), since the soft tissues of the supporting surface of the foot are subject to the same general pathomorphological laws as other tissues. Their shock-absorbing ability is determined by the thickness of the tissues, the size and shape of the fat lobes and the development of the fibroelastic framework, 70 which connects the dermis, plantar aponeurosis and periosteum, which are placed around the bones. Naturally, with trophic disorders, the mechanical properties of the tissues of the supporting surface of the foot, in particular, the heel, change. This is manifested by a change in thickness (atrophy), the degree of compression and the coefficient of elasticity (due to cicatricial degeneration) of soft tissues.

Considering the fact that the methods of assessing the condition of soft tissues in trophic disorders of the lower extremity in 12 different pathological conditions are either non-specific ("the foot is cold to the touch", "absence of pulsation in the arteries of the feet!", "hair loss on the feet and legs" and etc.), or require special equipment (rheovasography, dopplerography, angiography, etc.) (2).

We have proposed an integral method of assessing the state of the soft tissues of the lower limb, which allows you to determine the presence of trophic disorders, assess the viability of the limb and solve the issue of treatment tactics. 20 A known method of assessing the condition of soft tissues of the lower limb by visual description of skin color (for example, red, pale, cyanotic), the presence of edema, hyperkeratoses, ulcers, etc.) (21.

The disadvantages of this method are that it is subjective and cannot be used in the early stages of trophic disorders, since these changes are minimal or absent.

There is a known method of assessing the state of the soft tissues of the lower extremity by studying the arterial blood flow 25 (rheovasography, dopplerography, angiography, etc.) (2). Disadvantages of this method are the need to use complex and expensive equipment and involve a specialist to interpret the obtained data. In addition, it allows you to assess only the condition of the limb's blood supply, not taking into account the condition of nerve trophicity, oxygen saturation of tissues, the condition of microcirculation, etc.

The basis of a useful model is the task of creating a method of assessing the condition of the soft tissues of the lower limb by measuring the thickness of the soft tissues of the heel using ultrasound, which would allow. (/G(SZ) to reveal the presence of trophic disorders at any stage of the pathological process.

The problem is solved by the fact that in the method of assessing the condition of the soft tissues of the lower limb, which involves measuring the thickness of the soft tissues of the limb using ultrasound, according to a useful model, the thickness of the soft tissues of the supporting surface of the heel is measured with with and without load, 35 calculate their modulus of elasticity, and with modulus of elasticity indicators of "1.3 bkgs/cm? the presence of trophic disorders of the lower extremity is ascertained and diagnosed.

The method is explained illustratively. Fig. 1 shows a device for measuring the thickness of the soft tissues of the plantar surface of the heel (A - a platform for installing weights; B - bars connecting the platforms; B - a platform with a hole for with a hole for installing an ultrasonic sensor ). Fig. 2 shows the application of the ZZZ device when measuring the thickness of the soft tissues of the plantar surface of the heel (A - ultrasonic sensor installed on a platform with a hole; B - weight installed on the upper platform). In Fig. 3 - determination of the point of the standardized 1" measurement of the thickness of the soft tissues of the heel. And - line A drawn along the front edge of the Achilles tendon; II - line B, dividing the heel in half in the sagittal plane; Ii - the intersection of lines A and B on the sole surface of the heel.

Implementation of the claimed method is carried out as follows. The patient is placed on his stomach. Bending the lower extremity at an angle of 902 in the knee and ankle joints, the thickness of the soft tissues of the support surface of the heel is measured without load using ultrasound, for example, the Zietepe (av) Zopoiepe 0-50 device with a 7.5MHz linear sensor. Then they create a load with a weight of, for example, a weight of 5 kg at the standard position of the sensor, placing it perpendicular to the calcaneus at the intersection of two lines, 50 the first (A), which is arc-shaped through the plantar surface of the heel on both sides of the front surface (" c) Achilles tendon, and the second (B) that divides the heel into two parts in the sagittal plane. For the standardized placement of the sensor, use the device (Fig. 1), placing the sensor perpendicular to the calcaneus (Fig. 2), that is, measure the distance from the most distal point of the cortical layer of the calcaneus to the surface of the skin. To obtain an assessment of the state of soft tissues, the following indicators are measured: | o - the thickness of the soft tissues of the support surface of the heel without load, I - the thickness of the soft tissues of the support surface of the heel under load. The following values are calculated: there is (relative deformation) ; c - John 1

Io

E (modulus of elasticity or Young's modulus); 60 p

E where c is tension.

The tension is calculated according to the formula E" where E is the applied force, 5 is the area of application of the force (in 65 and o in all cases, both in the control and in the examined groups, the contact of the loaded surface of the plate with the sole surface of the heel was 19.625 cmM 2 ); 0 -0.255Kg/cm2.

Measurements of the thickness of the soft tissues of the supporting surface of the heel were carried out in 46 patients with obliterative angiopathy of various genesis: 35 - type II diabetes (58 feet), 11 - obliterative atherosclerosis of the vessels of the lower limb (19 feet). The age of the patients ranged from 36 to 78 years.

The control group was formed from 28 healthy volunteers (56 feet) aged 28 to 55 years who did not present any complaints about the lower limbs. So, the examinees were divided into three groups: And - control, And! - patients with diabetes mellitus (DM), PI - patients with obliterative atherosclerosis (OA). 10 The average values of the thickness of the soft tissues of the support surface of the heel were obtained, the relative deformation ( o ) and the modulus of elasticity (Е) were calculated by the observation groups. These data are presented in Table 1.

Average values of measured and calculated indicators characterizing mechanical

I

Measured and calculated indicators 20 z z o x - standard deviation;

Norma - control group; (uh)

DM - patients with diabetes;

OA - patients with obliterative atherosclerosis of the vessels of the lower extremity. ("in") 35 ! ! . ! ! ! ! with

Since, in fact, the thickness of the soft tissues of the plantar surface of the foot varies significantly in different individuals depending on height, weight, body structure, etc., a relative indicator characterizing the mechanical properties of the investigated tissues, namely, relative deformation, was analyzed. It does not depend on the anthropometric data described above. The modulus of elasticity (Young's) calculated on its basis has the following values. Normally, it is 1,076-1,364 kgf/cm2, with diabetes - 1,386-5,204 kgf/cm2, with OA - 1,536-2,452 kgf/cm2. A statistical statistical analysis was carried out using the Ehsei program! testified to the significance of the differences between the numbers of the modulus of elasticity in normal conditions and in trophic disorders. )» Thus, if the modulus of elasticity of the soft tissues of the supporting surface of the foot is more than 1.364 kgf/cm? those examined were diagnosed with trophic disorders of the lower extremity, the cause of which must be identified in order to prevent complications,

THAT ARISES over time. Clinical examples 1. Patient Z.E., 197 Or.n., ii. min. Мо486259, turned to the Polyclinic of the Institute of Medical Sciences of Ukraine on March 7, 2006 with complaints about the lack of fusion of the lateral bone of the left lower leg. Medical history: injury on January 23, 2006. because of

Go) fall. In the trauma center, an X-ray examination was performed, a diagnosis of a fracture of the lateral bone of the left 5th tibia was made without displacement, and a circular plaster bandage was applied from the tips of the fingers to the proximal third of the tibia. After 5 weeks, in connection with the lack of fusion, she was sent for consultation at the ITO of the AMS of Ukraine. o At the time of application, it was noted: the patient walks on crutches without putting any weight on the left lower limb, there is slight swelling of the soft tissues of the foot and the area of the ankle joint, more in the area of the lateral bone, palpation of the foot is painless, the range of motion in the ankle joint is limited, painless. dv X-ray: systemic osteoporosis, oblique fracture of the lateral bone without displacement and consolidation phenomena.

By the proposed method of Lyabach A.P. assessment of the condition of the soft tissues of the lower extremity was carried out. The modulus of elasticity of the soft tissues of the supporting surface of the heel on the left was 1.56kgf/cm2, on the right - 1.49kgf/cm2. The presence of trophic disorders in both lower limbs was diagnosed. During the additional examination of the patient, an increase in blood sugar in the morning up to 7.8 mmol/l was revealed. The diagnosis was established: diabetes, type 2, diabetic foot syndrome, neuropathic 60 form, osteoarthropathy of the left foot, lack of consolidation of the fracture of the lateral bone of the left tibia.

The patient was sent for consultation to an endocrinologist with recommendations to use orthopedic shoes with high tops. 2. Patient V.O., born in 1954, i. min. Mo486327, applied to the polyclinic of the ITO of the AMS of Ukraine on 13.03.2006 with complaints of pain in the head of the second metatarsal bone of the left foot, leg fatigue after walking and 65 loads. It is known from the anamnesis that these complaints appeared 1-1.5 years ago. In the polyclinic at the place of residence, a diagnosis was made at the same time: flattening of the front part of both feet, metatarsalgia on the left. VP-6 type insoles are prescribed. Due to the deterioration of the patient's condition, he asked for a consultation at the ITO of the AMS of Ukraine.

At the time of application, there was a flattening of the arch and flattening of the front parts of both feet, tenderness during palpation in the area of the head of the second metatarsal bone of the left foot on the plantar surface. In addition, the patient complains of paresthesias in both legs and reduced tolerance to cold. The pulsation of the arteries of the foot is reduced.

By the proposed method of Lyabach A.P. assessment of the condition of the soft tissues of the lower extremity was carried out. The modulus of elasticity of the soft tissues of the supporting surface of the heel on the left was 1.49 kgf/cm 2, on the right - 1.42 kgf/cm?. The presence of trophic disorders in both lower limbs was diagnosed. The patient underwent an ultrasound examination of the vessels of the lower extremities, during which an altered main type of blood flow 70 with a decrease in velocity parameters was found on the distal arteries of the limb, the diastolic phase was absent. ROM (peak systolic velocity) was 33.5cm/s on the back artery of the foot on the left, 30.2cm/s on the right (normal from 50 to 8Osm/s). Signs of stenosis were found on both popliteal arteries. In connection with the detected vascular pathology, the patient was referred to a vascular surgeon for consultation.

According to the research results, the following pattern appears: with trophic disorders of various severity and 75 etiology (diabetes, obliterating atherosclerosis, etc.), the mechanical properties of the soft tissues of the support heel deteriorate, which is manifested, first of all, in their thinning compared to the norm. Another feature is the deterioration of elasticity. Thus, the changes in the mechanical properties of the soft tissues of the supporting surface of the heel that we discovered reflect the presence of trophic disorders.

A.P. Lyabach's method assessment of the condition of the soft tissues of the lower extremity allows diagnosing the presence of trophic disorders, does not require special training and can be used in hospitals of various levels.

Literature taken into account during the examination: 1. Trofika // BMO. - Edition 3. - M., 1985. - P. 338-346. 2. Modern approach to the treatment of patients with diabetic foot syndrome / V.V. Hrubnyk, T.S. Rusevich,

E.A. Antsipovych, A.S. Pylypenko. - K.: Akadempress, 2002. - 70p. what with

Claims (1)

The formula of the invention is a method of assessing the condition of the soft tissues of the lower extremity, which involves measuring the thickness of the soft tissues of the extremity using ultrasound, which differs in that the thickness of the soft tissues of the supporting surface of the heel is measured with and without a load. calculate their modulus of elasticity and, with the modulus of elasticity of 21.36 kgf/cm, diagnose the presence of trophic disorders of the lower limb. ee "c) with no i" name) («c) (ee) («c) (42) 60 b5