RU2103977C1 - Method of treatment of joint osteoarthrosis - Google Patents

Abstract

FIELD: medicine; physiotherapy. SUBSTANCE: at first joint skin integument is coated with lipide extract and then thermovibromassage is performed at vibrator temperature of 40-42 deg, amplitude of 0.5-0.7 mm, at frequency of up to 100 Hz, for 3-5 min. This done, frequency is changed to 10 Hz and then increased gradually up to 35 Hz, with time of action of joint being 8-10 min. Lipide extract remainder on skin integument is used as base for application of compress for 1.5-2 h. Treatment course includes 10-12 procedures. EFFECT: more effective treatment due to intensification of peripheral hemodynamics and antiinflammatory action. 4 tbl

Description

 The invention relates to medicine, namely to physiotherapy.

 Known methods of treating degenerative diseases of the joints, for example, by exposure to a sinusoidal modulated current, low-frequency magnetic field [1].

 However, these methods are not sufficiently effective, since they do not provide full improvements in peripheral hemodynamics and activation of metabolic trophic processes in the joints.

 Closest to the claimed is a method of treating osteoarthritis by phonophoresis of a solution of "dry" brine (lake wine. Water) [2].

 However, this method is not effective enough (66%), since it is known that about 40% of ultra-acoustic energy is transmitted from the soft tissues to the bone, which is why there is no proper increase in blood flow to the articular and periarticular tissues of the joints and enhancement of metabolic processes. Moreover, ultrasound therapy can enhance joint tissue edema in the presence of reactive synovitis and has a number of contraindications, especially from the cardiovascular system.

 The invention consists in the following.

Patients with osteoarthritis of the joint of the I-III stages (with and without synovitis) are lubricated the skin of the joints with a lipid extract from the therapeutic mud (the method of obtaining it is protected by copyright certificate N 825080, published April 30, 81), then thermal vibration massage is carried out at a temperature of 40- 42 ^o C, with an amplitude of 0.5-0.7 mm, while at the beginning the specified massage is carried out with a frequency of 90-100 Hz, in order to relieve pain, within 3-5 minutes on each joint, the effect is carried out according to a labile technique, delaying vibratodes in painful areas, then transition it at a frequency of 10-12 Hz and gradually increase it to 35-37 Hz with a duration of exposure to the joint of 8-10 minutes, in order to enhance regional blood flow and metabolic and trophic processes in the tissues, after which the lipid extract remaining on the skin is used to subsequent application of a compress for 1.5-2 hours. During one procedure, more than two joints are affected, while for large and small joints, the appropriate vibratodes (mushroom or spherical) are selected, for a course of treatment 10-12 procedures that are carried out in polo the patient is lying or sitting.

 Distinctive features of the proposed method are the combined use of thermal vibration massage with varying parameters and lipid extract from therapeutic mud. According to pharmacological studies, a lipid extract has a high anti-inflammatory, analgesic and stimulating activity of metabolic trophic processes, and does not cause allergic reactions. Under the influence of vibration, timely tissue massage is carried out, leading to an increase in the number of active capillaries, sweat and sebaceous glands, through which biologically active components from therapeutic agents can penetrate. As you know, the structure of the skin belongs to capillary-porous bodies, and therefore the capillary effect can be considered as an important theoretical prerequisite in the use of thermal vibration massage to increase the permeability of the skin and cell membranes, enhance diffuse processes.

 Vibrational vibrations, in contrast to the prototype, have greater penetrating power, causing irritation not only of exteroreceptors, but also of deep-lying proprioreceptors of the joint capsule, blood vessels, muscles, tendons, which determines the nature of the response. So, it was found that low frequencies of 10-35 Hz stimulate the activity of the neuromuscular apparatus, the speed of excitation along the nerve, has a pronounced vasodilating effect, enhances metabolic and trophic processes in the tissues. High frequencies (90-100 Hz) have a strong anesthetic effect, they adapt peripheral receptors to mechanical vibrations, leading to a sharp decrease in the flow of pain impulses, as a result of which protective inhibition in the fodder cells of the brain and suppression of the pain dominant in the central nervous system develop.

 In order to develop frequency and time parameters, one-time thermometric and rheovasographic studies were carried out to study peripheral hemodynamics in the main vessels of the lower extremities, in the knee joints of healthy individuals under the influence of thermal vibration massage with a frequency of 10 to 100 Hz.

 As can be seen from the table. 1, the frequency of 100 Hz for the first 5 min of exposure causes an increase in blood flow and blood supply to the periarticular tissues, the continuation of thermal vibration massage to 10 min leads to a sharp decrease in the studied parameters to the initial level, which, apparently, is due to body fatigue and angiospasm.

 Thermo-vibro massager at a frequency of 10 to 35 Hz for 5 minutes does not cause a proper response from the joint tissues, after 10 minutes there was a significant increase in the temperature of the skin and blood filling of the periarticular tissues, subjectively - a sensation of warmth in them. It was found that this massage for more than 10 minutes can cause addiction, fatigue, as well as an exacerbation of the pathological process, especially with a complicated course of the disease.

 The results of a single study on healthy individuals served as the basis for further clinical study of the proposed method for the treatment of patients with osteoarthrosis.

 Three groups of patients with stage I – III osteoarthrosis were under observation.

 Group I - 25 patients who underwent only thermal vibration massage of the joints.

 Group II - 25 patients who received compressors with lipid extract from therapeutic mud.

 Group III - 32 patients who received thermal vibration massage in combination with a lipid extract from therapeutic mud.

 As can be seen from the table. 2 and 3 in patients who received only thermal vibration massage, there is an increase in peripheral blood flow and blood supply, an increase in the temperature of the skin in the joints, as evidenced by reliable indicators of electrothermometry, rheographic index and specific peripheral blood volume of tissue structures. At the same time, from the side of biochemical indicators reflecting inflammatory and metabolic processes, no dynamics were revealed. Subjectively, a pronounced analgesic effect was observed in patients.

 In the group of patients receiving compressors with lipid extract from therapeutic mud, in contrast to the first group, a pronounced anti-inflammatory, decongestant, and analgesic effect was observed. There was a tendency toward increased regional blood flow, but reliable hemodynamic parameters were not obtained.

 The data obtained as a result of clinical studies contributed to the creation of the proposed method, which results in a mutually reinforcing, synergistic effect.

 As can be seen from the table. 2 and 3, the inventive method helps to improve peripheral blood supply, reduce vascular tone, increase blood supply to the periarticular tissues, which entails an improvement in oxygen transport of plastic and energetic substances in connective tissue structures, i.e., enhances metabolic and trophic processes, and has a pronounced analgesic and anti-inflammatory effect.

 A gradual increase in the claimed frequencies (10-35 Hz) prevents the development of addiction and fatigue of the body to thermal vibration. The duration of the course of treatment of 10-12 procedures is due to a persistent response from the joints and is confirmed by clinical and paraclinical studies.

 In the table. 4 presents a comparative description of the proposed method and prototype.

 As can be seen from the table. 4, a decrease in joint pain in patients according to the claimed method was observed 1.2 times more often after 5-6 procedures, and their disappearance by the end of the course of treatment in 83% versus 11.1%. Tolerance of the procedures was good, no exacerbations were noted. Improvement of regional hemodynamics in patients was noted 1.4 times more often than in the prototype. The treatment efficiency was 87.9% versus 77.8%.

 Example 1. Patient S., aged 40, was admitted to treatment at the Tomsk Research Institute of Balneology and Physiotherapy with a diagnosis of deforming osteoarthritis with a primary lesion of the knee joints of the second stage.

 On admission, the following complaints were noted: aching, aching pain in the knee joints. The pains are pronounced, permanent, especially when descending the stairs, occur daily by the end of the day, in the first half of the night, pass after rest. Notes a feeling of heaviness and stiffness in the legs, stiffness, weakness, decreased performance. She was treated repeatedly on an outpatient basis.

 Objectively: the skin of the knee joints is of a normal color, there is no hyperemia. On the right is determined prepatellar synovitis. Movements in both knee joints with passive and active movements are limited, crunch. On palpation along the joint space there are pain points. From other joints and the spine, pathological changes were not detected.

Laboratory and functional data: X-ray of the knee joints - stage II deforming osteoarthrosis: rheovasography - an increase in vascular tone, a decrease in blood flow intensity and specific peripheral vascular blood filling, a rheographic index (RI) on the right - 0.5 OM, on the left - 0.5 OM , on the left, 0.45 OM with a norm of 0.6 ± 0.02 Ohms; specific peripheral blood volume (UPOC) on the right 4.8; on the left - 4.7, with a norm of 5.3 ± 0.08. Marked asymmetry in the temperature of the skin in the area of the knee joints at various points by 0.5-1.5 ^o . On the part of electrocardiographic indicators, a moderate sinus bradycardia of 53 beats was detected. in 1 min. the deviation of the electrical axis to the left, the position is horizontal. Single ventricular extrasystole.

 Biochemical parameters: glycosaminoglycans (GAG) - 0.3 g / l (with a norm of 0.18 - 0.28 g / l); hydroxyproline 3.8 μg / ml (at a rate of 1.2-2.5 μg / ml); sialic acids 3.0 mmol / d (at a rate of 1.9-2.5 mmol / l).

The patient was prescribed treatment in accordance with the claimed method. At the beginning, the skin of the knee joints was smeared with a lipid extract from the therapeutic mud, then thermo-vibration massage with a vibratode temperature of 42 ^o C, an amplitude of 0.7 mm, with a frequency of 100 Hz for 5 min for each joint was held, delaying the vibratode at the pain points, then passed at a frequency of 10 Hz, gradually increasing it to 35 Hz with a duration of 10 minutes on each joint, then the remnants of the lipid extract on the skin were used as the basis for applying a compress for 2 hours. The procedures were released daily on two joints. In total, 12 procedures were performed on the patient's course.

 The patient tolerated the treatment well; exacerbations of the pathological process were not noted. Gradually, the general condition improved. The intensity of pain by the 6-7 procedure significantly decreased, and by the end of the course of treatment disappeared. The range of motion in the knee joints increased, the synovitis phenomena disappeared, and ease of movement appeared.

 On the part of rheovasographic indicators, positive dynamics was observed. An increase in peripheral blood flow and blood supply to the periarticular tissues was observed. The asymmetry of the temperature of the skin of the knee joints disappeared. RI on the right and on the left - 0.6 OM, UPOC on the right - 5.2; to the left - 6.4. The rates of inflammatory and metabolic trophic processes in the connective tissue structures of the epiphyseal cartilage normalized (GPAG - 0.22 g / l; hydroxypropyl 2.5 μg / ml; sialic acids 2.2 mmol / l).

 The patient was discharged with a significant improvement. Long-term results of treatment showed that the stage of remission lasted for 12 months.

 Thus, as a result of using the proposed method, there was a significant improvement in peripheral hemodynamics, increased blood supply to the periarticular connective tissue structures, which enhances metabolic trophic processes, the activity of the neuromuscular apparatus, suppresses inflammatory processes in the synovial membrane of the joints, has a pronounced analgesic effect, while the inventive method unlike the prototype, it has no contraindications. It is easily feasible both on an outpatient basis and in any health care facilities.

Sources of information
1. Issues of resort rheumatology: Sat. scientific tr / M-in healthcare of the RSFSR, Pyatigorsk Research Institute of Balneology and Physiotherapy. Pyatigorsk: 1986, p. 96.

 2. Stolova T.G., Golosova L.O. Ultraphonophoresis of the solution of "dry" brine in the complex treatment of patients with primary osteoarthritis // The effectiveness of sanatorium treatment in the health resorts of Siberia and the Far East and the prospects for their development; Sat scientific tr / Magadan: 1990, p. 26-28 (prototype).

Claims (1)

A method of treating osteoarthritis of the joints by introducing a solution of lake mineral water through the skin by mechanical vibrations, characterized in that the skin integument areas of one or two joints with a previously applied lipid extract from the healing mud are subjected to thermal vibration massage with a vibrator temperature of 40 42 ^o С, amplitude 0.5 0 , 7 mm, at the same time, at the beginning, the specified massage is applied with a frequency of 90 to 100 Hz for 3-5 minutes on each joint, with a longer effect on the pain points, then they switch to a frequency of 10 12 Hz with a gradual e an increase of 35 37 Hz with a duration of exposure to the joint of 8 10 minutes, after which the lipid extract remaining on the skin is used as the basis for the subsequent application of a compress for 1.5 2 hours, for a course of 10 12 procedures.

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