RU2161517C2 - Method for treating tissue repair regeneration disorders of locomotor system - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves subjecting pathological focus to three-four fold alternation of local negative pressure within the limits of 720 to 730 mm of mercury column 1-2 min long and local positive pressure within the limits of 770 to 780 mm of mercury column 0.5-1 min long 15-20 times daily. The method is supplied with a set of glass hemispheres having diameter from 20 to 80 mm with light guides from laser radiator and air-conducting tube implanted into them and connected to rarefaction compressor. Wavelength is equal to 0.63 mcm. Power density is from 0.5 to 1.5 W/см². EFFECT: enhanced effectiveness of treatment; circular irradiation of lesion focus; active blood supply zone created in the injured zone. 1 dwg

Description

 The present invention relates to medicine, namely to traumatology and orthopedics. A known method of electrical stimulation of osteoreparation in case of delayed consolidation of fractures (Tkachenko S.S., Rutsky V.V. Electrical stimulation of osteoreparation. L., 1989, pp. 9-17) and a method for correcting degenerative-dystrophic disorders of the musculoskeletal system using implanted optical fibers ( Berglezov M.A., Vyalko V.V., Ugnienko V.I. Methods of invasive laser therapy in traumatology and orthopedics. M., 1995, p. 6 - 7). However, the invasive techniques themselves, the high cost of the equipment and the relative complexity of the procedure do not allow widespread use of the method in clinical practice.

 There is a method for treating sluggishly granulating wounds, chronic ulcers, and delayed bone fusion by directly irradiating the site of destruction with light from a low-energy helium-neon laser (Bogdanovich U. Ya., Gordeeva LI, Krasnoshchekova EE Laser in traumatology and orthopedics. In book. : Means and methods of quantum electronics in medicine, M., 1976, pp. 71-72), which was taken as a prototype, but with such use of laser light there is a large dissipation of energy and, as a result, loss upon absorption, it is impossible to circularly irradiate start the destruction and create an active blood supply zone at the site of damage.

 The proposed method can be used in outpatient practice and inpatient conditions, allows you to more accurately determine the absorbed dose of radiation and create a local dosed blood supply to the soft tissues of the damage zone, makes it possible to circularly irradiate the limb.

 The aim of the invention is the activation and optimization of regenerative and reparative processes in case of damage to the musculoskeletal system (prevention and treatment of delayed consolidation of fractures and false joints, treatment of injuries and degenerative-dystrophic diseases of the skin and underlying tissues). A brief schematic description of the method is given in the drawing.

 A method for the treatment of disorders of reparative regeneration of the musculoskeletal system was as follows.

 Three glass hemispheres coated inside with a special composition with scattering and reflective properties (depending on the shape and size of the anatomical segment and the pathological focus, the simultaneous number of hemispheres used ranged from three to five), with a diameter of 20 mm to 80 mm in section, was implanted optical fibers from a laser source with a wavelength of 0.63 microns, an output power of 15-20 mW, for example, SHATL-1, and air ducts with a diameter of 4 mm leading to a vacuum compressor, which allows you to create alternately negative noe and positive pressure.

Pre-prepared hemispheres were circularly applied to the site of damage and first they created a dosed local negative pressure in the range from 720 to 730 mm RT. Art. for 2 minutes, then dosed local positive pressure up to 770 - 780 mm RT. Art. at the same exposure. At the same time, laser light created an energy effect with a power density of 0.5 to 1.5 mW / cm ^2. The exposure of one procedure was 10 minutes. The course of treatment was limited to 15 to 20 daily procedures with a possible repetition, if necessary, at least 30 days later. In order to select the optimal exposure regimen and its correction, as well as to objectify the healing process against the background of baro-laser treatment, radiation thermal imaging of the damage zone was carried out every 3 to 4 days prior to irradiation.

 The above method of treating reparative regeneration disorders was applied in 12 patients. 8 of them suffered delayed consolidation of fractures and pseudoarthrosis of the tubular bones of the lower extremities, and 4 patients had chronic lower limb ulcers against the background of post-traumatic trophic disorders and venous insufficiency of the lower extremities. As a result of the treatment, in combination with well-known methods, all 12 patients had positive dynamics, manifested in subjective reduction or disappearance of pain, reduction of edema and signs of inflammation, activation of reparative-regenerative processes and, ultimately, healing of fractures and wound healing in optimal terms . Clinical manifestations clearly confirmed laboratory and thermal imaging studies, expressed in the rapid normalization of blood tests and thermographic dynamics of the damage zone.

 The following clinical observations are cited as an example.

 Patient T., 42 years old, and / b N 1257, was hospitalized in the 22nd department of RNIITO named after P.P. Harmful from 02.20.96 to 03.22.96 due to the delayed consolidation of the oblique fracture of the upper third of the left tibia. Injury 07/07/95, fell down the stairs. He was treated conservatively at the place of residence with a diagnosis of open oblique fracture of the upper third of the right tibia. Plaster immobilization for 5 months with a course of physiotherapeutic procedures and physiotherapy exercises. Upon admission to the institute’s clinic, the patient had palpation tenderness in the upper third of the left leg, a slight club-shaped thickening and mild swelling. The skin was not changed, pathological mobility was not observed, walking with additional support (crutch). On a roentgenogram of the lower leg bones in 2 projections, the fracture line with a pronounced periosteal reaction was not fragmented without violating the anatomical axis of the limb. A patient underwent a course of dosed local baro-laser therapy in the amount of 10 procedures in combination with generally accepted restorative techniques (FTL, exercise therapy, massage, swimming pool, mechanotherapy, nonspecific biostimulants). After 3 procedures, the state of health significantly improved, the pain and swelling of the lower leg decreased. At the end of the course of treatment, walking with an additional support (cane) was possible. On the control roentgenogram - the phenomena of induced callus formation according to the type of intramedial bone callus, which was confirmed by the data of a dynamic thermal imaging study. Re-examined 05/20/96 - walks without additional support, movement in the joints in full, able-bodied.

 Patient T., 41 years old, and / b N 2095, was hospitalized in the 22nd department of RNIITO named after P.P. Harmful from 26. 03. 96 to 04.17.96 due to the stiff false joint of the left tibia in the lower third. Injury 5.02.95, fell on the street. She was treated in the hospital at the place of residence, where the Ilizarov apparatus was placed on 02.16.95. 05/16/95 the apparatus was removed due to the lack of fusion of the tibia and a plaster cast was applied. Upon admission, pathological mobility in the lower third of the leg, impossibility of axial load was determined. On the roentgenogram of the left lower leg there were phenomena of the formed false joint. 04.04.96 an operation was performed - resection of the pseudoarthrosis, metal osteosynthesis of the left tibia with a compression plate with bone autoplasty. In the postoperative period, the patient underwent a course of dosed local baro-laser therapy in the amount of 8 procedures, followed by the application of a circular plaster cast. During treatment, the temperature quickly returned to normal, pain and postoperative swelling decreased, and the patient's general condition stabilized. In the postoperative period, local complications were not observed.

 Patient 3., 48 years old, and / b N 1837, was hospitalized in the 22nd department of RNIITO named after P.P. Harmful from 03/18/96 to 04/19/96 due to a closed fracture of both ankles of the right lower leg with displacement of fragments, varicose veins, chronic recurrent ulcers of the lower third of the right lower leg. Injury 03/18/96, fell on the street. Suffers from varicose veins of the superficial veins of the right lower leg for 10 years, periodically noted the appearance of ulcers in the lower third of the right lower leg. In the last 4 weeks, there was a relapse of a trophic ulcer along the inner surface of the lower third of the right lower leg with a size of 1.5 x 1.0 cm. Upon admission to the institute's clinic, a closed manual reposition of fragments was made, and a graduated plaster cast was applied. Against the background of thermal imaging control, a course of local dosed baro-laser therapy in the amount of 8 procedures was carried out using antiseptics and ointment dressings. Complete ulcer healing was noted 2 weeks after treatment. On day 20, a circular plaster cast was applied. A control examination after 8 weeks revealed a clear formation of bone callus of both bones of the right lower leg with the correct position of the fragments, recurrence of varicose ulcers was not observed. The results of the clinical application of the method of treating disorders of the reparative regeneration of the musculoskeletal system in combination with generally accepted methods indicate pronounced anti-inflammatory, activating and optimizing manifestations against the background of local dosed baro-laser therapy. Thermal imaging control at all stages of treatment allows you to objectify the process and conduct dynamic correction of therapy.

Claims (1)

A method for treating disorders of the reparative regeneration of tissues of the musculoskeletal system, including external laser irradiation on the area of the pathological focus, characterized in that to reduce the treatment time by creating favorable conditions: for reparative regeneration in the pathological focus three to four times more are applied daily alternating local negative pressure in the range from 720 to 730 mm RT. Art. 1 - 2 min and local positive pressure in the range from 770 to 780 mm Hg 0.5 - 1 min each, provided by a set of glass hemispheres with a diameter of 20 to 80 mm, into which air tubes connected to a vacuum compressor and optical fibers from a laser emitter with a wavelength of 0.63 microns and a power density of 0.5 to 1.5 mW / cm ² .