Khimich O. Transtibial amputation in patients with occlusive angiopathy

The work is dedicated to improving the results of transtibial amputation in patients with suppurative - necrotic complications of obliterating angiopathy based on removal of soleus muscle and the development of prognostic criteria on the possibility of saving the knee joint. The thesis analyzes clinical and laboratory, radiological investigations and surgical treatment of 99 patients with obliterating angiopathy who were made high amputation and histological study of surgical specimens, taken during limb amputations. Using histological experiment a greater degree of pathological changes of the soleus muscle against the gastrocnemius one with a decreasing number of functioning capillaries by 19.3% (p <0.01) in patients with chronic critical ischemia of the lower limb IV degree by Fontain was found. These changes confirm the feasibility removal soleus muscle while performing transtibial amputation (TTA) in patients with purulent necrotic complications of obliterating angiopathy. It was found that the results of patients treatment with purulent necrotic complications of obliterating angiopathy, whom TTA was carried out by a modified technique for all indicators were higher than in patients for whom classical technique of TTA was used. It was studied the impact of certain factors on the ability of saving the knee joint. Statistical significance (p <0.05) of the three predictors was established (Ankle-brachial index - ABI, the level of Hb, index comorbidity - IC); and their averages were: ABI - 0,47 ± 0,05; Hb - 103 ± 6 g / l; IC - 5,3 ± 0,2. Thus, these figures are the predictors,according to which it may be predicted a level of lower extremity amputations in patients with necrotic suppurative complications of obliterating angiopathy (with saving or without saving the knee joint). This pattern can be expected in 63% of cases. This regression model has good sensitivity (0.83) and high specificity (0.96), making it suitable for use in clinical practice. It was studied that the quality of life in patients with necrotic suppurative complications of obliterating angiopathy who were underwent lower extremity amputations with preserved knee joint is higher than in patients without knee joint (EQ VAS SF-5; p <0,05).