Year 2017 Vol. 25 No 4

GENERAL & SPECIAL SURGERY

N.M. KLYUSHIN, M.V. STOGOV, L.A. GREBENYUK, A.S. SUDNITSYN, E.A. KIREEVA

COMPARATIVE ANALYSIS OF PATHOPHYSIOLOGICAL SIGNS OF OSTEOMYELITIS OF NEUROGENIC- TROPHIC AND POSTTRAUMATIC ETIOLOGY

FSBE Russian Scientific Center Restorative Traumatology and Orthopedics Named after Academician G.A. Ilizarov,
Kurgan
The Russian Federation

Objectives. Comparative evaluation of the pathophysiological manifestations of the calcaneal osteomyelitis of neurogenic-trophic and post-traumatic etiology.
Methods. 19 patients were examined (mean age 45,34,8, history of disease: 2-5 years) with neurogenic-trophic osteomyelitis of the calcaneus (group 1) and 42 patients (mean age 41,75,0, history of disease: from 7 months to 6 years) with post-traumatic osteomyelitis of the calcaneus (group 2). Evaluation of clinical and radiological picture of patients was carried out; physiological and laboratory tests were performed.
Results. A comprehensive study has revealed the characteristic pathological features of patients with osteomyelitis of neurogenic-trophic and post-traumatic etiology. In patients of the 1st group osteomyelitic focus was localized mainly on the supporting surface of the calcaneus; in patients of the 2nd group it was localized in the area of the consolidated fracture or false joint of the calcaneus. Body mass index of patients in the 1st group was 30,92,4, in the 2nd group 27,42,2 (p<0,05). In patients of the 1st group the tissue perfusion in the damaged foot segment tissues relatively to the contralateral parameters was 17-32% higher (p<0,05), which was not observed in patients of the 2nd group. According to infrared thermometry the tendency of local temperature reduction on the affected foot and leg was registered in patients of the 1st group. The concentration of fibrinogen in group 1 was reliably higher than in the group 2 (p<0,05). The activity of bone isoenzyme of acid and alkaline phosphatase in the serum of patients in the 1st group was within the normal range; in patients of the 2nd group it was elevated.
Conclusion. The patients with neurogenic-trophic osteomyelitis are characterized by the following pathophysiological features: impaired neurogenic vascular response in the tissues of the segment affected by osteomyelitis, hypercoagulation and loss of neurotrophic control.

Keywords: osteomyelitis of calcaneus, pathophysiology, microcirculation, infrared thermometry, blood biochemistry, haemostasis, hypercoagulation
p. 382-388 of the original issue
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Address for correspondence:
640014, Russian Federation,
Kurgan, M. Ulyanova str.,
6, FSBE "Russian Research
Center "Restorative Traumatology and
Orthopedics" named after
Academician G.A. Ilizarov"
Tel.: 8 (3522) 45-05-38,
E-mail: stogo_off@list.ru,
Maxim V. Stogov
Information about the authors:
Klyushin N.M. MD, Head of clinic of purulent osteology, FSBE Russian Scientific Center Restorative Traumatology and Orthopedics named after Academician G.A.Ilizarov.
Stogov M.V. MD, Ass. Professor, Leading Researcher of the biochemistry laboratory, FSBE Russian Scientific Center Restorative Traumatology and Orthopedics named after Academician G.A.Ilizarov.
Grebenyuk L.A. PhD (Biology), Senior Researcher of laboratory of purulent osteology and replacement of limb defects of FSBE Russian Scientific Center Restorative Traumatology and Orthopedics named after Academician G.A.Ilizarov.
Sudnitsyn A.S. Traumatologist- orthopedist of the clinic of purulent osteology, FSBE Russian Scientific Center Restorative Traumatology and Orthopedics named after Academician G.A.Ilizarov.
Kireeva E.A. PhD (Biology), Senior Researcher of the biochemistry laboratory, FSBE Russian Scientific Center Restorative Traumatology and Orthopedics named after Academician G.A.Ilizarov.
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