Молодежный инновационный вестникМолодежный инновационный вестник2415-7805Федеральное государственное бюджетное образовательное учреждение высшего образования "Воронежский государственный медицинский университет имени Н.Н. Бурденко" Министерства здравоохранения Российской Федерации9065Conference ProceedingsTAXONOMICAL APPROACH TO ASSESSMENT, EARLY DETECTION, PREVENTION AND TREATMENT OF CRUZARTHROSISNazarovVladimir Anatolyevichnazarov_v_a@mail.ruhttps://orcid.org/0009-0004-5375-2633ZakrevskiyKonstantin Vladimirovichdrzak@rambler.ruhttps://orcid.org/0009-0005-9578-2264KhairutdinovAlexandersanchous39rus@gmail.comhttps://orcid.org/0009-0007-1119-4313First Pavlov State Medical University of St. Petersburg2912202312240452305202314072023Copyright © 2023, Nazarov V.A., Zakrevskiy K.V., Khairutdinov A.2023<p><strong>Introduction.</strong> Vascular disorders that cause changes in the trophism of the subchondral layer of the tibial bone lead to changes in the trabecular bone tissue system and loss of cartilage elasticity. Hematomas form at the early stages of acute trauma, leading to separation of cartilage from bone. The aim of the study was to determine the degree of influence of different available surgical treatment methods on patients with acute and chronic vascular disorders and cruralgia. <strong>Materials and methods.</strong> 33 patients underwent examination and treatment using arthroscopy, X-ray diagnostics, and MRI. 12 patients had a history of injury of more than 1 year and/or a disease manifested as chronic vascular disorders of the tibial bone, while 21 patients had a history of injury from 3 weeks to 1 year ago. Statistical methods were used, including statistical observation, grouping of statistical observation materials, absolute and relative statistical values. <strong>Results.</strong> Patients were divided into three groups depending on the time of injury. The first group was up to three weeks, the second group was from three weeks to a year (divided into two subgroups), and the third group had injuries over a year ago with chronic vascular disorders in the tibial bone area. Patients in the first group were treated on an outpatient basis and were not included in the study. In the second group, 13 people were in subgroup A, and 8 people were in subgroup B. No significant limitations of daily activities were found. After surgery, patients in subgroup A were able to walk a distance of at least one kilometer without discomfort but complained of pain when descending stairs. In the third group, 12 patients all complained of a deterioration in the quality of life and nocturnal cruralgia. Arthrodesis was performed to improve the quality of life of patients in the third group and did not cause complications. <strong>Discussion.</strong> Debridement is effective in injuries up to 1 year ago, improving the quality of life, delaying radical operations, reducing cruralgia, and increasing joint range of motion. Arthrodesis improves the quality of life of patients with injuries over 1 year ago. Delayed treatment of joint cartilage defects leads to arthrosis and disability. MRI and arthroscopy are recommended for diagnosing joint pathology. <strong>Conclusion.</strong> Arthroscopic interventions improve the life and functioning of damaged joints, delaying radical operations. The mechanism of improved blood circulation requires further investigation.</p>pain syndromearthrodesiscirculatory disorderstrophic disordersflotationsubchondral zoneosteoperforationarthroscopyБолевой синдромартродезированиенарушение кровообращениятрофические нарушенияфлотациясубхондральная зонаостеоперфорацияартроскопия1.Корнилов Н. В. Травматология и ортопедия / Корнилов Н. В. , Грязнухин Э. Г. , Шапиро К. И., Корнилов Н. Н. , Осташко В. И. , Редько К. Г. , Ломая М. П. - Москва : ГЭОТАР-Медиа, 2014. - 592 с.: глава 7.2.Kornilov NV, Traumatology and orthopedics / Kornilov N., Gryaznukhin EG, Shapiro KI, Kornilov NN, Ostashko VI, Redko KG, Lomaya MP. - Moscow: GEOTAR-Media, 2014. - 592 p.: chapter 7. (In Russ.).3.Егиазарян К.А., Лазишвили Г.Д., Храменкова И.В. с соавт. Алгоритм хирургического лечения больных с рассекающим остеохондритом коленного сустава. Вестник РГМУ 2018;2:77–83. https://doi.org/10.24075/vrgmu.2018.020.4.Egiazaryan KA, Lazishvili GD, Hramenkova IV et al. Knee osteochondritis desiccans: surgery algorithm. Bulletin of the Russian State Medical University 2018;2:77–83. (In Russ.). https://doi.org/10.24075/vrgmu.2018.020.5.Jaleel A, Golightly YM, Alvarez C et al. Incidence and progression of ankle osteoarthritis: The johnston county osteoarthritis project. Semin Arthritis Rheum 2021;51(1):230235. https://doi.org/10.1016/j.semarthrit.2020.10.015.6.Sahni T., Gupta S. Case report: Treatment of bone marrow edema of femoral head with hyperbaric oxygen therapy // Apollo Med. 2016. 13. (1). 59-62;7.Kanemitsu M, Nakasa T, Ikuta Y, Ota Y, Sumii J, Nekomoto A, Sakurai S, Adachi N. Characteristic Bone Morphology Change of the Subtalar Joint in Severe Varus Ankle Osteoarthritis. J Foot Ankle Surg. 2022 May-Jun;61(3):627-632. doi: 10.1053/j.jfas.2021.10.026. Epub 2021 Oct 29. PMID: 34823970.8.Зейналов В.Т., Карданов А.А., Корышков Н.А., Левин А.Н., Самков А.С., Гаврилова Н.С., Шайкевич А.В., Особенности хирургической коррекции посттравматической вальгусной деформации голеностопного сустава сопровождающейся остеоартрозом у пациентов с плосковальгусной деформацией стоп// Кафедра травматологии и ортопедии. 2016.№4(20). с.25-329.Zeynalov VT, Kardanov AA, Koryshkov NA, Levin AN, Samkov AS, Gavrilova NS, Shaikevich AV, Features of surgical correction of post-traumatic valgus deformity of the ankle joint accompanied by osteoarthritis in patients with planovalgus deformity of the feet// Department of Traumatology and Orthopedics. 2016. No. 4(20). p.25-3210.Myers S.L., Stankovic A. et al. Amyloid deposits in human knee and hip joints // Rheumatol. Intern. 1985. Vol. 5, N 211.Khlopas H, Khlopas A, Samuel LT, Ohliger E, Sultan AA, Chughtai M, Mont MA. Current Concepts in Osteoarthritis of the Ankle: Review. Surg Technol Int. 2019 Nov 10;35:280-294. PMID: 31237341.12.Копьева Т.Н. Синовит при остеоартрозе (клинико-морфологическое исследование: Ревматология. / Т.Н. Копьева, М.Г. Астапенко, А.Г. Арутюнов. -1988.-№4.-С. 47-52.13.Kop'eva TN. Synovitis in osteoarthritis (clinical and morphological study: Rheumatology. / TN Kopeva, MG Astapenko, AG Arutyunov. -1988.-No. 4.-S. 47-52.14.Strobel, Michael J., Manual of Arthroscopic surgery Vol.1, 2012; https://static-eu.insales.ru/files/1/1507/2000355/original/shtrobel_1.pdf15.Dahmen J, Karlsson J, Stufkens SAS, Kerkhoffs GMMJ. The ankle cartilage cascade: incremental cartilage damage in the ankle joint. Knee Surg Sports Traumatol Arthrosc. 2021 Nov;29(11):3503-3507. doi: 10.1007/s00167-021-06755-w. Epub 2021 Oct 5. Erratum in: Knee Surg Sports Traumatol Arthrosc. 2022 Aug;30(8):2881. PMID: 34609539; PMCID: PMC8514360.16.Nery C, Baumfeld D. Anterior and Posterior Ankle Impingement Syndromes: Arthroscopic and Endoscopic Anatomy and Approaches to Treatment. Foot Ankle Clin. 2021 Mar;26(1):155-172. doi: 10.1016/j.fcl.2020.07.002. Epub 2020 Sep 9. PMID: 33487238.17.Chen S, Miller JD, Steinberg JS. Management of the Charcot Foot and Ankle: Nonreconstructive Surgery. Clin Podiatr Med Surg. 2022 Oct;39(4):559-570. doi: 10.1016/j.cpm.2022.05.003. Epub 2022 Aug 6. PMID: 36180188.18.Qu W, Dong S, Wang D, Zhao H, Sun Z, Li W. Treatment of Early to Intermediate Stage Ankle Osteoarthritis With Nonosteotomy Approaches: Intermediate-Term Efficacy. J Foot Ankle Surg. 2022 Mar-Apr;61(2):333-338. doi: 10.1053/j.jfas.2020.07.008. Epub 2021 Sep 17. PMID: 34635406.19.Manke E, Yeo Eng Meng N, Rammelt S. Ankle Arthrodesis - a Review of Current Techniques and Results. Acta Chir Orthop Traumatol Cech. 2020;87(4):225-236. English. PMID: 32940217.20.Stukenborg-Colsman C, Ettinger S, Claassen L, Daiwei Y, Plaass C. Umstellungsosteotomien bei Arthrose am Sprunggelenk (supra- und inframalleolar) – Was kann man erwarten? : Kritische Übersicht der Literatur [Conversion osteotomy for arthrosis of the ankle joint (supramalleolar and inframalleolar)-What can be expected? : Critical review of the literature]. Unfallchirurg. 2022 Mar;125(3):189-195. German. doi: 10.1007/s00113-022-01142-7. Epub 2022 Feb 11. PMID: 35147709.21.Coetzee JC, McGaver RS, Seiffert KJ, Giveans MR. Management of Ankle Arthritis After Severe Ankle Trauma. J Orthop Trauma. 2020 Feb;34 Suppl 1:S26-S31. doi: 10.1097/BOT.0000000000001697. PMID: 31939777.22.Umans H, Cerezal L, Linklater J, Fritz J. Postoperative MRI of the Ankle and Foot. Magn Reson Imaging Clin N Am. 2022 Nov;30(4):733-755. doi: 10.1016/j.mric.2022.05.006. PMID: 36243515.23.Saengsin J, Bhimani R, Sato G, C Hagemeijer N, Mirochnik K, Lubberts B, R Waryasz G, W DiGiovanni C, Guss D. Use of portable ultrasonography for the diagnosis of lateral ankle instability. J Orthop Res. 2022 Oct;40(10):2421-2429. doi: 10.1002/jor.25256. Epub 2022 Jan 5. PMID: 34985144.24.Eelsing R, Hemke R, Schepers T. The added value of SPECT/CT in the painful foot and ankle: A review of the literature. Foot Ankle Surg. 2021 Oct;27(7):715-722. doi: 10.1016/j.fas.2020.09.009. Epub 2020 Sep 30. PMID: 33046381.25.Gross CE, Barfield W, Schweizer C, Rasch H, Hirschmann MT, Hintermann B, Knupp M. The utility of the ankle SPECT/CT scan to predict functional and clinical outcomes in supramalleolar osteotomy patients. J Orthop Res. 2018 Jul;36(7):2015-2021. doi: 10.1002/jor.23860. Epub 2018 Mar 22. PMID: 29427441.26.Smiljanic Tomicevic L, Hocevar A, Sukara G, Cubelic D, Mayer M. The frequency and characteristics of ultrasonographic ankle joint involvement in systemic lupus erythematosus: A prospective cross-sectional single-center study. Medicine (Baltimore). 2022 Aug 5;101(31):e29196. doi: 10.1097/MD.0000000000029196. PMID: 35945784; PMCID: PMC9351871.27.Ахметжан А.Д. Критерии диагностики и оценки эффективности комплексного консервативного лечения больных посттравматическим крузартрозом. Автореф. дис. канд. мед. наук. Новосибирск. 2009. 25 с.]. https://medical-diss.com/medicina/kriterii-diagnostiki-i-otsenki-effektivnosti-kompleksnogo-konservativnogo-lecheniya-bolnyh-posttravmaticheskim-kruzartroz28.Akhmetzhan AD. Criteria for diagnosis and evaluation of the effectiveness of complex conservative treatment of patients with post-traumatic crusarthrosis. Abstract dis. cand. honey. Sciences. Novosibirsk. 2009. 25 p.]. https://medical-diss.com/medicina/kriterii-diagnostiki-i-otsenki-effektivnosti-kompleksnogo-konservativnogo-lecheniya-bolnyh-posttravmaticheskim-kruzartroz29.Jantzen C, Ebskov LB, Andersen KH, Benyahia M, Rasmussen PB, Johansen JK. [Ankle arthrosis]. Ugeskr Laeger. 2020 Oct 12;182(42):V04200244. Danish. PMID: 33046192.30.Schaefer K.L. et al., 201231.Eroshenko AV, Eroshkin IA, Zubova EA, Kovylov AO, Krasnoshchekova LS. Endovascular arterialization of deep crural and pedal veins in a patient with critical lower limb ischaemia. Angiol Sosud Khir. 2021;27(3):54-65. English, Russian. doi: 10.33529/ANGIO2021317. PMID: 34528589.32.Kehrer M, Kohlhof H, Schwetje D, Kasapovic A, Kehrer A, Wirtz DC, Friedrich MJ. Basic Clinical Examination of the Foot and Ankle. Z Orthop Unfall. 2020 Dec;158(6):657-660. English, German. doi: 10.1055/a-1209-3971. Epub 2020 Sep 28. PMID: 32987440.33.Leiß F, Schwarz T, Baier C, Grifka J. Klinische Untersuchung des Fußes [Clinical examination of the foot]. Orthopade. 2019 Jun;48(6):541-552. German. doi: 10.1007/s00132-019-03748-z. PMID: 31127331.34.Vieira Cardoso D, Ruffieux E, Valisena S, Monsellato E, Hannouche D. Arthrose de la cheville : pourquoi si jeune, et quelle option thérapeutique ? [Management of ankle osteoarthritis in the young adult]. Rev Med Suisse. 2021 Dec 15;17(763):2173-2179. French. PMID: 34910403.35.Kim J, Kim JB, Lee WC. Clinical and Radiographic Results of Ankle Joint Preservation Surgery in Posterior Ankle Arthritis. Foot Ankle Int. 2021 Oct;42(10):1260-1269. doi: 10.1177/10711007211011182. Epub 2021 Jun 6. PMID: 34092125.