diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM13118diaendo-13118Research ArticleОбзорыReviewКлассификация нейроостеоартропатии Шарко: эволюция взглядов и нерешенные проблемыClassification of the Charcot neuroosteoarthropathy: evolution of views and unsolved problemshttps://orcid.org/0000-0002-5285-8303БреговскийВ. Б.BregovskiyV. B.

Бреговский Вадим Борисович - д.м.н.

194354, СПб ул. Сикейроса, д. 10Д; тел.: 8(921)301-14-15

Vadim B. Bregovskiy - MD, PhD.

10D Sikeyros str., 194354, St-Petersburg

podiatr@inbox.ruhttps://orcid.org/0000-0003-4943-3440ОсначС. А.OsnachS. A.

Оснач Станислав Александрович

Москва

Stanislav A. Osnach - MD.

Moscow

stas-osnach@yandex.ruhttps://orcid.org/0000-0003-1276-5484ОболенскийВ. Н.ObolenskiyV. N.

Оболенский Владимир Николаевич - к.м.н.

Москва

Vladimir N. Obolenskiy - MD, PhD.

Moscow

gkb13@mail.ruhttps://orcid.org/0000-0001-8126-8452ДеминаА. Г.DeminaA. G.

Демина Анастасия Геннадьевна - к.м.н. врач кабинета "Диабетическая стопа"

Anastasia G. Demina - MD, PhD.

ans.dem@bk.ruhttps://orcid.org/0000-0002-5547-4524РыбинскаяА. Л.RybinskayaA. L.

Рыбинская Анастасия Леонидовна - врач травматолог-ортопед.

Москва

Anastasia L. Rybinskaya - MD.

Moscow

arybinskay@mail.ruhttps://orcid.org/0000-0002-5077-2186ПроцкоВ. Г.ProtskoV. G.

Процко Виктор Геннадьевич - д.м.н. Доцент кафедры травматологии и ортопедии РУДН.

Москва

Victor G. Protsko - MD, PhD.

Moscow

89035586679@mail.ruСанкт-Петербургский территориальный диабетологический центрРоссияSt-Petersburg City diabetes CentreRussian FederationГородская клиническая больница им. С.С. ЮдинаРоссияSergey Yudin City HospitalRussian FederationГородская клиническая больница №13; Российский национальный исследовательский медицинский университет им. Н.И. ПироговаРоссияClinical hospital №13; Pirogov Russian National Research Medical UniversityRussian FederationКонсультативно-диагностический центр Генерального штаба ВС РФРоссияConsultative and Diagnostic Center of the GS of the RF Armed ForcesRussian FederationГородская клиническая больница им. С.С. Юдина; Российский университет дружбы народовРоссияSergey Yudin City Hospital; RUDN UniversityRussian Federation202404092024274384394Copyright © Бреговский В.Б., Оснач С.А., Оболенский В.Н., Демина А.Г., Рыбинская А.Л., Процко В.Г., 20242024Бреговский В.Б., Оснач С.А., Оболенский В.Н., Демина А.Г., Рыбинская А.Л., Процко В.Г.Bregovskiy V.B., Osnach S.A., Obolenskiy V.N., Demina A.G., Rybinskaya A.L., Protsko V.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/13118

Диабетическая нейроостеоартропатия Шарко — проявление синдрома диабетической стопы, сопровождающееся высоким риском образования трофических язв и ампутации. Многие аспекты этой патологии ввиду ее особенностей остаются плохо изученными, что ведет к сложностям в определении тактики лечения пациентов. В обзоре проводится анализ классификаций артропатии Шарко, построенных по анатомическому и «функциональному» принципам. Основное внимание уделено поражениям среднего отдела стопы как наиболее тяжелым по своим последствиям. Проанализированы преимущества и недостатки разных подходов к описанию рентгенологической картины заболевания на разных его стадиях. Систематизация литературы позволяет сделать вывод о том, что существующие подходы к классификации относительно приемлемы с точки зрения планирования консервативного лечения. В то же время подробные анатомо-рентгенологические классификации не помогают в выборе тактики реконструктивного хирургического лечения. В свете увеличения доступности реконструктивной хирургии при тяжелых деформациях вследствие артропатии Шарко представляется целесообразной разработка классификационных систем, которые могли бы стать инструментом определения хирургической тактики при данной патологии.

Diabetic Charcot neuroosteoarthropathy is a manifestation of diabetic foot syndrome, accompanied by a high risk of foot ulcers and amputation. Many aspects of this pathology due to its features remain poorly understood, which leads to difficulties in determining the tactics of treatment of these patients. This review analyzes of anatomical and functional classifications of Charcot foot. The review focuses on the midfoot pathology as the most severe in their consequences. The advantages and disadvantages of different approaches to the description of the X-ray picture of the disease at its various stages are analyzed. The systematization of the literature allows us to conclude that the existing approaches to classification are relatively acceptable mainly when planning conservative treatment. At the same time, detailed anatomical and radiological classifications do not help in choosing the tactics of reconstructive surgical treatment. With the increasing availability of reconstructive surgery for severe deformities due to Charcot’s arthropathy, it seems appropriate to develop classification systems that could become a practical tool for determining surgical tactics in this pathology.

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The authors declare that there are no conflicts of interest present.