Piatkovskyi V. Diagnostics and treatment of the diabetic osteoarthropathy of the foot

The analysis of complex clinical, laboratory, radiological, biochemical, immunological researches and the treatment of 129 patients with diabetic osteoarthropathy (DOAP) of the foot have been presented in the thesis. By clinical, laboratory and radiological researches the diagnostic criteria of DOAP of the foot have been established. The sensitivity and the specificity of Brodsky test were defined. The interrelation between osteolysis, raised blood concentration of calcium and heterotopic ossification of the soft tissues at DOAP were established and it was proved that osteolysis and the raised blood concentration of calcium is peculiar to acute stage of the illness. There is a normalization of level of calcium in blood and disappearance of such symptoms of the acute stage as a hyperemia and hyperthermia occurred in chronic stage. In mineral metabolism at DOAP the increase of concentration of calcium and phosphorus in blood serum, decrease of the activity of alkaline phosphatase and the content of the ionized calcium that revealed to oppression of the anabolic processes in the bone tissue of the patients have been observed. The metabolism of the hyaline cartilage at DOAP is characterized by sharp decrease in the content of collagen and increase in the content of the glycosaminoglycan that does this disease similar to physiological process of aging. In immunological research the essential decrease of the clonogenic activity of the stromal founder cells (SFC) of the bone marrow not only in the focus of defeat, but also in the pelvic bone that displays the low regenerating potential of the bone tissue at DOAP is established; however the relative osteogenic activity of SFC of the bone marrow in acute stage of the diabetic osteoarthropathy is kept significantly. Reconstructive surgical treatment of the diabetic osteoarthropathy of the foot in acute stage accelerates transition to the chronic stage, provides good anatomic and functional results (84 - 91 points by AOFAS scale) and has a number of advantages in comparison with surgical treatment in chronic stage (74 - 88 points by AOFAS scale). Except the best resultant function, technical performance of the surgical intervention in acute stage is easier, the possibility of stable internal fixation remains and the terms of treatment of patients are reduced.