DIRECT AND LONGTERM RESULTS OF THE TREATMENT OF PATIENTS WITH THE NEUROPATHIC FORM OF THE DIABETIC FOOT SYNDROME

Abstract. Introduction. Damage to the nervous system in patients with diabetes mellitus (DM) is one of the most frequent complications (80-90%). Diabetic polyneuropathy (DPN) in patients with type 2 diabetes already occurs at the time of diagnosis of diabetes. The purpose of the study. To improve the results of treatment of patients with the neuropathic form of complicated SDS and to find out the immediate and long-term results of treatment. Materials and methods. 274 patients with the neuropathic form of complicated SDS who were being treated in the purulent-septic center with beds for diabetic foot of the CNP «City Hospital No. 3» were examined. Zaporizhzhia for the period 2013-2024. Patients were divided into two groups. The main group consisted of 166 (60.6%) patients with the neuropathic form of complicated SDS, who underwent a full clinical and laboratory, neurological examination, instrumental examination of the hemodynamics of the upper and lower extremities (ultrasound of the arteries and LDF) and received treatment according to the developed algorithm from 2016 to 2024 year The comparison group included 108 (39.4%) patients with the same pathology, with a similar examination plan, who received treatment from 2013 to 2016, who, according to the gender ratio (c2 = 0.09; P = 0.7698), concomitant pathology and age (P = 0.117141) did not differ from the main group. The results. After 3 years, it was possible to assess the results of treatment in 69.9% of patients. In patients with plantar ulcers of the distal part of the foot in the main group, 40% more cases of complete ulcer healing were found than in the comparison group (Р<0.0136) and 41.0% less cases of repeated formation of foot ulcers (Р<0.0016). In the main group, the number of staged necroctomies and dissections of phlegmons or foot abscesses was statistically lower (χ2 = 4.76; P = 0.0291). The average bed-day in the main group was (15.2 ± 0.66) days, which is probably lower than in the comparison group (19.7 ± 1.19) (t = 4.32; P < 0.0001). Postoperative mortality among patients in the main group is twice as low as in the comparison group 2.1% and 5.6%, respectively. The total number of repeated surgical interventions was probably lower among patients in the main group (χ2 = 11.8; P = 0.0006). During this period, 13.2% more «high» amputations were performed in patients from the comparison group (χ2 = 4.53; Р = 0.0333). Also, the number of performed repeated «small» amputations is 20.0% higher in the comparison group (χ2 = 5.63; Р = 0.0177). In 50.5% of patients of the main group, after three years of observation, positive dynamics were noted — a decrease in the size or complete healing of a trophic ulcer or a postoperative wound, as well as the absence of new purulent-necrotic complications in the area of the affected foot. Among the patients of the comparison group, such patients were 37.5% less (χ2 = 19.39; P < 0.0001). Conclusions. The main reason for repeated hospitalizations in the neuropathic form of SDS is recurrent ulcers of the front part of the foot, and the addition of infection leads to the development of osteomyelitis or phlegmon. The presence of pronounced neuropathy in complicated SDS is the main criterion for surgical intervention as prevention of recurrent ulcer formation.