Evaluation of long-term results of treatment of patients with complicated diabetic foot syndrome and determination of ways of rendering medical-social assistance
DOI:
https://doi.org/10.11603/2414-4533.2017.3.8127Keywords:
complicated diabetic foot syndrome, sepsis, analysis of long-term results.Abstract
The aim of the work. The structure of the long-term results of treatment of patients with complicated DFS with the definition of the indicator of the physical and psychological components of health, the state of their prosthetics and the correction of shoes in orthopedic workshops is analyzed.
Materials and Methods. There were 724 patients with complicated DFS aged 36 to 87 years under observation. In 71 (9.8 %) patients, the disease was complicated by sepsis. 36 patients with complicated DFS without sepsis died (lethality 5.5 %) and 42 patients with sepsis (lethality 59.1 %). For outpatient treatment, 617 patients with complicated DFS and 29 patients who had sepsis were discharged. The terms of the control examination were: 6 months, 1, 2, 3 an d 5 years.
Results and Discussion. The index of physical and psychological components of health in half a year did not exceed 43.2 ± 4.7 conv. units in patients who underwent "small" amputations and 31.3 ± 3.6 conv. units (P <0.05) in patients after "high" amputations. After 2 years, there was no improvement on the part of these spheres. Only one patient is prosthodontic, less than 25 % of patients use orthopedic footwear. Patients who recovered from sepsis and were discharged from the hospital: 11 (42.3 %) died during the first year or even early, and 12 (46.2 %) for 2 to 3 years. After 5 years, the following data were obtained: Among 364 patients who operated on gangrene of the lower extremity, 23 (6.3 %) survived, and a "high" amputation of the contralateral limb was performed in 48 (13.2 %) of patients, out of 253 patients, in the anamnesis of whom there were "small" amputations, for 5 years they operated on the forefoot of this limb in 14.2 % of cases (36 patients), on the contralateral limb – 31 (12.2 %), 127 (50.2 %), the fate of the remaining 17 (6.7 %) is not established. Long-term results in patients with complicated DFS testify to the absence of dynamic observation of these patients at the outpatient stage of treatment. It is optimal that the questions of prosthetic patients after "high" amputations and the selection of orthopedic shoes for patients after "small" would be included in the National Di abetes Care Program.
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