Единого определения понятия «хроническая рана» до сих пор не существует. Можно встретить термины «длительно незаживающая рана», «проблемная» или «сложная» рана, «трофическая язва» (различного генеза). Одни только трофические язвы нижних конечностей по этиологическому фактору могут быть венозные, артериальные, на фоне диабетической нейропатии и ангиопатии, гипертонические (синдром Марторелла), при системных заболеваниях (болезни крови, обмена веществ, коллагенозы, васкулиты, например ливедо-васкулит), нейротрофические, рубцово-трофические, фагеденические (прогрессирующая эпифасциальная гангрена); застойные (на фоне НК), пиогенные, специфические и инфекционные, малигнизированные (новообразования кожи), при токсическом эпидермальном некролизе Лайелла, при врожденных пороках развития сосудистой системы-ангиодисплазиях, лучевые, артифициальные и язвы, развившиеся вследствие воздействия физических факторов [1]. Единого временного критерия определения хронической раны также нет. Одни авторы хронической считают рану, существующую более 4 нед. без признаков активного заживления; исключение составляют обширные раневые дефекты с признаками активной репарации [2]. Другие авторы считают хронической рану, не заживающую при адекватном лечении в течение 6 нед. [3, 4]. Так, в 1983 г. группа шотландских исследователей под руководством J. Dale дала определение хронической трофической язвы нижней конечности как «...открытой раны на голени или стопе, не заживающей более 6 нед.». Есть мнение, что хронической следует считать рану, не заживающую в течение 8 нед. [5, 6]. Согласно определению специального заседания Европейского общества репарации тканей (Сardiff, Wales, сентябрь 1996), «хронической следует считать рану, не В.Н. ОБОЛЕНСКИЙ, к.м.н., Городская клиническая больница №13 Департамента здравоохранения г. Москвы, Российский национальный исследовательский медицинский университет им. Н.И. Пирогова, Москва СОВРЕМЕННЫЕ МЕТОДЫ ЛЕЧЕНИЯ ХРОНИЧЕСКИХ РАН Автор приводит обзор литературных данных, посвященный проблеме терминологии и классификации хронических ран, а также обзор методов местного лечения таких ран с иллюстрациями из собственной клинической практики. Ключевые слова: хроническая рана, методы лечения. V.N. OBOLENSKIY, PhD State financed health institution City clinical hospital No. 13 Board of Health of Moscow, State financed educational institution, Higher professional education institution Russian National Research Medical University named after N.I. Pirogov, Moscow MODERN TREATMENT METHODS OF THE CHRONIC WOUNDS The author gives a review of published data on the problem of terminology and classification of chronic wounds, as well as an overview of methods for the topical treatment of wounds with illustrations from his own clinical practice.
The objective is to present a clinical case of successful treatment of a patient with recurrent spondylitis at the cervical level.Clinical case. A 65-year-old patient was diagnosed with purulent spondylodiscitis at the level of C6-C7 vertebrae with the epidural and paravertebral abscesses and spinal cord compression. Emergency left colotomy, paravertebral abscess dissection, corporectomy of the C6 vertebra, abscess removal, anterior spondylodesis with bone autograft and titanium plate were performed. Massive antibacterial therapy was prescribed. After the operation, the volume of movement in the left limbs was restored, and on the 15th day after the operation, the patient was discharged. On the 36th day after discharge, she was hospitalized again with hematuria. A recurrence of suppuration in the area of the operation and phlegmon of both feet was revealed. Revision of the surgical wound and rehabilitation of the purulent focus on the neck, surgical intervention for phlegmon were performed. In purulent foci, Staphylococcus aureus was verified, which is sensitive to the main antibacterial drugs. Antibacterial therapy was continued, then, after changing the microflora in the wound, other antibiotics were prescribed. There was a pain in the area of the left spinal root C5. The connection of the fistula course with the titanium plate, the increase of pathological kyphosis at the level of the overlying vertebrae was found. The wound was examined, the titanium plate was removed, and the halo device was applied to correct the pathological kyphosis. After the operation, the radicular pain syndrome regressed, and the axis of the cervical spine was restored. After 1 month, the posterior combined fixation of the cervical spine at the C3-Th7 level was performed, and the halo device was dismantled. After 6 months, the patient was stopped wearing the Philadelphia neck collar, no recurrence of suppuration was observed, and a complete regression of neurological disorders was noted. After 1 year, a complete bone block is preserved between the C4-C7 vertebrae.Conclusion. The presented clinical case clearly illustrates the complexity of managing patients with inflammatory diseases of the cervical spine. Currently, there is no single treatment strategy for patients with spondylitis.
Object. To assess the effectivity and safety of different tibiocalcaneal arthrodesis types in treatment of patients with Charcot ankle deformity depending on disease severity. Materials and methods. We have analyzed the outcomes after treatment of 16 patients with diabetic neuropathic ankle arthropathy (Charcot ankle) at the stage of septic complications in bones of ankle and subtalar joints. The observation period was more than 1 [1–3] year. Ilizarov fixator for TCA was used in 8 cases; internal fixation with cannulated screws was applied in 8 cases.Results. In the early periods (up to 1 month from the operation) no complications were revealed. Complications in later terms developed in 4 patients: three with internal fixation and one with external.Conclusion. In our opinion, when choosing foot fixation tactics for heel-tibial arthrodesis, risk groups should be considered stage D according to Rogers classification and stage 3 according to Wagner classification, and after resection of bones in these patients external fixation is preferable. In the remaining stages, internal fixation is advisable because of the patient's higher quality of life and shortening of the rehabilitation period.
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