asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2024-038asurgery-482Research ArticleКОМОРБИДНЫЕ СОСТОЯНИЯCOMORBID STATESОстеоартроз коленных суставов или варикозная болезнь нижних конечностей: что первично?Osteoarthrosis of the knee joints or varicose veins of the lower extremities: Which comes first?https://orcid.org/0000-0002-5043-7193ЯровенкоГ. В.YarovenkoG. V.

Яровенко Галина Викторовна, д.м.н., профессор кафедры госпитальной хирургии

443099, Россия, Самара, ул. Чапаевская, д. 89 

Galina V. Yarovenko, Dr. Sci. (Med.), Professor of the Department of Hospital Surgery

89, Chapaevskaya St., Samara, 443089, Russia 

yarovenko_galina@mail.ruhttps://orcid.org/0000-0001-7473-6692КаторкинС. Е.KatorkinS. E.

Каторкин Сергей Евгеньевич, д.м.н., профессор, заведующий кафедрой и клиникой госпитальной хирургии 

443099, Россия, Самара, ул. Чапаевская, д. 89 

Sergey E. Katorkin, Dr. Sci. (Med.), Professor, Head of the Department and Clinic of Hospital Surgery

89, Chapaevskaya St., Samara, 443089, Russia 

katorkinse@mail.ruhttps://orcid.org/0009-0004-7678-2878СмагинЕ. В.SmaginE. V.

Смагин Егор Валерьевич, клинический ординатор, кафедра хирургии с курсом сердечно-сосудистой хирургии Института последипломного образования 

443099, Россия, Самара, ул. Чапаевская, д. 89 

Egor V. Smagin, Clinical Resident of the Department of Surgery with a Course in Cardiovascular Surgery of the Institute of Postgraduate Education 

89, Chapaevskaya St., Samara, 443089, Russia 

smaginegor@yandex.ruhttps://orcid.org/0009-0008-2487-9239КольцовА. Е.KoltsovA. E.

Кольцов Антон Евгеньевич, клинический ординатор, кафедра хирургии с курсом сердечно-сосудистой хирургии Института последипломного образования 

443099, Россия, Самара, ул. Чапаевская, д. 89 

Anton E. Koltsov, Clinical Resident of the Department of Surgery with a Course in Cardiovascular Surgery of the Institute of Postgraduate Education 

89, Chapaevskaya St., Samara, 443089, Russia 

koltsovantoha@yandex.ruСамарский государственный медицинский университетРоссияSamara State Medical UniversityRussian Federation202419112024212178189Copyright © Яровенко Г.В., Каторкин С.Е., Смагин Е.В., Кольцов А.Е., 20242024Яровенко Г.В., Каторкин С.Е., Смагин Е.В., Кольцов А.Е.Yarovenko G.V., Katorkin S.E., Smagin E.V., Koltsov A.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/482

Остеоартроз коленных суставов и варикозная болезнь нижних конечностей – два распространенных заболевания, которые довольно часто встречаются у пациентов в сочетании. Какая же патология является первичной? Это важный вопрос для специалистов, так как профильное лечение проводится в разных хирургических подразделениях, и зачастую без коррекции венозного оттока отсутствует возможность оперативного лечения коленного сустава. На основе литературы и личного опыта нами установлена возможная связь между этими двумя заболеваниями с попыткой определить, какое из них будет первопричинным. Анализ литературы проводился с использованием баз данных Elsevier, PubMed, eLibrary, PLOS и Киберленинка. Были проанализированы статьи, содержащие ключевые слова: остеоартроз, гонартроз, варикозная болезнь, нижние конечности, коленный сустав, венозный застой. Изучены англоязычные и русскоязычные полнотекстовые статьи, обзоры литературы, системные обзоры, метаанализы, когортные исследования и традиционные обзоры с глубиной поиска не более 35 лет. Существует теория, что патогенез остеоартроза и варикозной болезни вен непосредственно связан с ММР-9 и -12. При развитии этих заболеваний происходят ферментные нарушения в результате ремоделирования тканей. Соответственно, можно предположить, что эти болезни имеют одинаковое патофизиологическое происхождение. Однако установлено, что наиболее распространенной является теория, определяющая варикозную болезнь нижних конечностей как первопричину остеоартроза коленного сустава. По нашему мнению, рассматривать оба заболевания как первопричину не следует. Наличие одной патологии может усугублять клиническую картину другой. Проведя одноцентровое рандомизированное проспективное исследование у 40 пациентов с варикозной болезнью нижних конечностей, нами было выявлено, что у 24 из них с клиническими проявлениями остеоартроза коленного сустава диагностировались клинические классы варикозной болезни С3–С5 по CEAP.

Osteoarthritis of the knee joints and varicose veins of the lower extremities are two common diseases that quite often occur in combination in patients. What pathology is primary? This is an important issue for specialists, since specialized treatment is provided in different surgical departments and often without correction of the venous outflow there is no possibility of surgical treatment of the knee joint. Based on the literature and personal experience, we have established a possible connection between these two diseases with an attempt to determine which of them will be the root cause. The literature analysis was carried out using Elsevier, PubMed, eLibrary, PLOS and Cyberleninka databases. Articles containing the keywords: osteoarthritis, gonarthrosis, varicose veins, lower extremities, knee joint, venous congestion were analyzed. English and Russian full-text articles, literature reviews, systemic reviews, meta-analyses, cohort studies, and traditional reviews with a search depth of no more than 35 years were studied. It has been established that the most widespread theory is one that identifies varicose veins of the lower extremities as the root cause of osteoarthritis of the knee joint. In our opinion, both diseases should not be considered as the root cause. The presence of one pathology may aggravate the clinical picture of another. Having conducted a single-center randomized prospective study in 40 patients with varicose veins of the lower extremities, we found that 24 of them, with clinical manifestations of osteoarthritis of the knee joint, were diagnosed with clinical classes of varicose veins C3–C5 according to CEAP.

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