RU2194485C2 - Method for treating vertebrogenic deficiency of brain circulation and device for its implementation - Google Patents

Abstract

FIELD: medicine, physiotherapy. SUBSTANCE: one should use the traction of vertebral cervical department from 0.5 kg at the angle of onward pull ranged 0- 20 deg. at 5 deg. interval. At the same time one should measure the pull vector in frontal plane at the presence of asymmetry of pulse blood inflow by vertebral arteries. On achieving the maximal blood inflow at optimal pull vectors in two planes - sagittal and frontal - one should continue the traction at established parameters for the pull's power and vector. EFFECT: higher efficiency of therapy. 4 dwg, 2 ex, 6 tbl

Description

 The invention relates to medicine, is intended for vertical traction of the cervical spine and can be used to treat vertebrogenic insufficiency of cerebral circulation (VNMK).

 The prototype of the proposed method and device is "A method for the treatment of vertebrogenic insufficiency of cerebral circulation and a device for its implementation" (II Velikanov, IG Ignatiev, patent 1805945 dated 03.25.1991, application 4921829), in which, with the aim of improving cerebral circulation in case of its vertebrogenic insufficiency, a chair with a vertical stand with a horizontal bar attached to it, movable in a vertical plane, a Glisson loop connected through a block with a flexible thread to the cargo platform is used. The full-length horizontal rod has a groove in which a slider is placed with an additional unit and a fastening element connected through a flexible rod with a Glisson loop.

 Improving cerebral circulation by increasing pulse blood flow is achieved by stretching the cervical spine with optimal traction parameters in terms of strength and traction vector in the sagittal plane, performed under rheoencephalographic control.

 The disadvantages of this method and device is the following.

 1. In the presence of asymmetry of the pulse blood flow in the vertebral arteries, this asymmetry is not always eliminated by stretching the cervical spine when the traction vector in the sagittal plane changes. This is due to the peculiarities of the relationship of pathologically changed elements of the vertebral-motor segments in cervical osteochondrosis with the vertebral artery located in a narrow channel of the transverse processes of the cervical vertebrae.

 2. Incomplete opening of the vertebral arteries during traction of the cervical spine with a change in the thrust vector only in the sagittal plane limits the effectiveness of the treatment of vertebrogenic insufficiency of cerebral circulation with the treatment method and device for its implementation.

 Based on the foregoing, we propose a method for the treatment of vertebrogenic insufficiency of cerebral circulation and a device for its implementation.

 The essence of the method is as follows. In order to improve cerebral circulation by eliminating the asymmetry of the pulse blood flow through the vertebral arteries, which is not achieved when the traction vector is changed only in the sagittal plane, it is proposed to change the vector in the frontal plane, which is achieved by adding I.I. to the device Velikanova and I.G. Ignatiev (1991) a design element that allows you to change the thrust vector not only in the sagittal, but also in the frontal plane, which eliminates or reduces the asymmetry of blood flow in the vertebral arteries. After reaching the maximum blood flow in both vertebral arteries with optimal traction parameters in two planes (sagittal and frontal), traction is continued with the set parameters of force and traction vector.

 The device for the treatment of VNMK contains a chair, a vertical stand with a horizontal bar attached to it in the sagittal plane, movable in the vertical and frontal planes, having a groove in which a slider is placed with an additional unit equipped with a fastening element connected through a flexible rod with a Glisson loop. In order to eliminate or reduce the asymmetry of the pulse blood flow through the vertebral arteries and, consequently, improve cerebral blood flow by increasing the pulse blood flow, there is a device in the form of a protractor with the designation in degrees attached to it by a sleeve on a fixed vertical stand, which allows you to determine the optimal vector traction in the frontal plane by displacing the horizontal rod together with the movable vertical column around the axis of the stationary vertical column.

 The method is as follows.

 The drawing (figure 1) shows a device for implementing the method.

 The device comprises a chair (1) with a stand rigidly attached to its back (2), hollow inside, in which a movable stand (3) is placed with a horizontal bar (4) attached to it. The stand (3) is fixed in a fixed position with a sleeve (5) and a screw (6). A stop (7) is attached to the upright post for the horizontal post (4). The horizontal rod (4) has a groove along the trapezoidal cross section along which the slider is located with the block (8) and the screw (9) securing the slider in the desired position. A cable (11) is thrown through the blocks (8) and (10), one end of which is connected to the dynamometer (12) and the crossbeam (13), at the ends of which the rings of the Glisson loop (14) are attached. At the other end, the cable is connected to the platform (15), on which the load (16) is located. A device in the form of a protractor (17) is attached to the stationary vertical strut (17) with the designation of degrees (Fig. 2), which makes it possible to determine the optimal thrust vector in the frontal plane by displacing the horizontal rod (4) together with the movable strut (3) around the axis of the stationary vertical racks. The device (17) is attached to a vertical stationary rack (2) with the help of a sleeve (18) and a screw (19) (Figs. 1 and 2).

The device operates as follows. The patient is seated in a chair (1), a rheograph and an electrocardiograph are connected, a rheoencephalogram and an ECG are recorded in the initial state, then a Glisson loop (14) is put on the head, it is fixed on the crossbar (13), and using the slider (8) the thrust vector is set to zero position. The lower point of the axis (vector) is located in the lower vertebral-motor segment of the cervical spine. After that, gradually (with an interval of 30 s) the load is increased - 0.5; 1.0; 1.5; 2.0 kg, controlling the traction on the dynamometer (12). While maintaining the traction force of 1.5 or 2.0 kg, use the slider (8) to change the forward thrust vector by 5, 10, 15, 20 ^o , recording the rheoencephalogram in the occipito-mastoid lead (intracranial section of the vertebral-basilar pool) in each slider position. After determining the optimal traction parameters by the value of the maximum increase in pulse blood supply to the arteries in the sagittal plane, in the case of asymmetry of the pulse blood flow in the vertebral arteries, the optimal traction parameters in the frontal plane are determined, for which the horizontal bar (4) is moved in the opposite direction from the artery with a reduced pulse blood flow, recording REG every 5 ^o movement of the rod to 15-20 ^o . If the asymmetry of the pulse blood supply in the REG does not change or changes little, the horizontal bar begins to move towards the vertebral artery with reduced blood flow, also recording the REG after every 5 ^o displacement of the bar.

 After determining the optimal traction parameters by the value of the maximum increase in pulse blood supply in both vertebral arteries when the traction vector in the sagittal and frontal planes changes, the traction procedure is carried out for 10-12 minutes, after which the traction is gradually (in the reverse order) every 30 seconds reduced to zero. Then record the rheoencephalogram. At each ethane, the study surveys the patient's well-being. In the following procedure, it is carried out daily at the established optimal parameters, not earlier than 1-1.5 hours after eating and with an interval of 1.5-2 hours with other procedures. The course consists of 7-10-12 traction.

 In the table. 1 shows the dynamics of the pulse blood supply to the vessels of the vertebral-basilar basin (according to the rheographic index) in the examined group of patients in the process of determining the optimal traction parameters of the SHOP according to the proposed method. As can be seen from the table, the pulse blood flow during traction by the prototype method (without rotation, i.e., when the thrust vector changes only in the sagittal plane) with OPT was lower - 1.02 ± 0.06 cu (d) and 1.04 ± 0.08 y. e. (s), and with a rotation of 1.24 ± 0.07 and 1.29 ± 0.07, respectively. The asymmetry coefficient of pulse blood flow through the vertebral arteries decreased with a change in the thrust vector only in the sagittal plane from 47.1 ± 10.1 to 45.8 ± 8.3%, and with a change in the thrust vector in the sagittal and frontal planes - from 47.1 ± 10.1 to 24.2 ± 2.8%. The significance of differences was higher in the latter case (according to Student's test, p <0.01 and according to Fisher p <0.01).

 In the table. 2 shows the dynamics of the pulse blood supply to the vessels of the vertebral-basilar basin (according to the rheographic index) in a group of patients in the process of determining the optimal traction parameters for SHOP using the prototype method. As can be seen from the table, a decrease in the asymmetry of the pulse blood supply to the vertebral arteries was less pronounced compared with the proposed method.

 Clinical characteristics of patients and dynamics of symptoms as a result of course treatment. In the experimental group, 22 people were monitored, of which 6 were men and 16 were women. The main age is 45-59 years (16 people). The initial manifestations of insufficiency of blood supply to the brain were diagnosed in 7, dyscirculatory encephalopathy of the 1st art. - at 12, II Art. - in 3. Transient ischemic attacks in the vertebral-basilar system (CHD) have a history of 7 patients; 2 people suffered a stroke with minimal residual symptoms in the CHD and 1 person suffered a “big” stroke in the carotid pool. In 6 patients, stenosis of the internal carotid arteries was verified, in 11 - stenosis of the vertebral arteries. In 3 patients, lesions of arteries in both vascular pools were noted. 1 patient underwent brain revascularization surgery. Cervical osteochondrosis was detected in 13 patients, polysegmental osteochondrosis - in 9. Extravasal irritative-compression effects on the vertebral arteries were detected in all patients. Hypertension I-II Art. noted in 8, angina pectoris - in 7 people; 2 patients in the past suffered myocardial infarction.

 There were 23 people in the control group, of which 10 were men and 13 were women. The main age is 45-59 years (15 people). The initial manifestations of insufficiency of blood supply to the brain were diagnosed in 5, dyscirculatory encephalopathy of I st. - at 14, II Art. - in 4. Transient ischemic attacks in CHD have a history of 4 patients; 2 people suffered a stroke with minimal residual symptoms in CHD. In 5 patients, stenosis of the internal carotid arteries was verified, in 12 - stenosis of the vertebral arteries. In 1 patient, lesions of arteries in both vascular pools were noted. Cervical osteochondrosis was detected in 10 patients, polysegmental osteochondrosis - in 13. Extravasal irritative-compression effects on the vertebral arteries were revealed to one degree or another in all patients. Hypertension I-II Art. noted in 11, angina pectoris I-II FC - in 12 people.

 In the table. 3 and 4 show the performance of REG in the course of treatment with the use of traction in the proposed method (experimental group) and the prototype method (control group).

 As can be seen from the data in table 3, at the end of the traction course, optimized for the thrust vector in the sagittal and frontal planes (according to the proposed method), the asymmetry coefficient of pulse blood supply to the vertebral arteries decreased to a greater extent and more significantly compared to the group of patients treated by the prototype method . Also to a greater extent and more significant was the increase in pulse blood flow through the vessels of the carotid pool during the course of traction by the proposed method. The difference in the asymmetry coefficient was insignificant (Table 4).

 The dynamics of subjective and objective symptoms of patients of the experimental (22 people) and control (23 people) groups is presented in Table 5. As can be seen from the table, the dynamics of subjective and objective symptoms in the control group was slightly less pronounced.

As can be seen from table 6, the effectiveness of the course application of traction in the proposed method was higher compared with the prototype method (χ ² = 10.3; P <0.01).

 Thus, the use of the proposed device for the treatment of vertebrogenic insufficiency of cerebral circulation in patients with initial asymmetry of pulse blood supply through the vessels of the vertebral-basilar system has a more pronounced positive effect on the dynamics of clinical symptoms and REG-indicators compared to the prototype method.

 The method and device are illustrated by the following examples.

EXAMPLE 1
B-naya K-na, 53 years old, teacher, medical history 1190, was treated from September 16 to October 10, 1996 with a diagnosis of chronic cerebrovascular insufficiency, mainly in the vertebral-basilar system, cerebral arteriosclerosis of the 1st stage, consequences of craniocerebral trauma (1992 g), post-traumatic fixed body antelysthesis C ₃ , osteochondrosis C _3-7 III st., deforming spondylosis C _3-4 ; vertebrogenic craniocervicalgia; arterial hypertension, including regional cerebral.

 Received complaints of frequent headache attacks, dizziness, nausea, pain in the craniocervical junction and cervical spine, fainting conditions, rapid fatigue, memory loss.

In 1992, she suffered a craniocerebral trauma with loss of consciousness (up to 40 min) with a subluxation of C ₃ , the development of post-traumatic anelisthesis, deforming spondylosis and a gradual increase in the above symptoms.

 Upon admission to the neurological department of the Kislovodsk clinic: pulse - 60 min, satisfactory properties, blood pressure 160/90 mm Hg, temporal blood pressure - 85 mm Hg on the left, right artery spasmodic.

Movements in the cervical spine are limited: turning to the right - up to 10 ^o , left - up to 35 ^o , back - up to 20 ^o . Soreness of paravertebral points along the spine. The pupils are narrowed, the reaction to light is weakened, the deviation of the tongue to the right, weak convergence on both sides; the Marinescu-Radovici reflex is revealed (on the right). Hypesthesia C ₅ -D ₁ segmental type (right). Reflexes on the hands are lowered (d = s), knee reflexes are satisfactory (s> d). In the Romberg position - staggering, when performing a finger test - miss on both sides.

 An examination of the blood revealed an increase in the level of total cholesterol to 6.7 mmol / L, including β-lipoproteins up to 63 conv. unit, dysproteinemia. According to REG, the pulse blood supply in the hemispheres is sufficient (RI = 0.125 Ohm on the right and 0.1 Ohm on the left), in the vertebral-basilar system it is reduced (RI = 0.094 Ohm on the right and 0.045 Ohm on the left).

 On the ECG - diffuse disturbances of repolarization processes.

On radiographs of the cervical spine - a moderate decrease in the height of the intervertebral discs C _2-7 ; body antelysthesis C ₃ by 4 mm relative to C ₄ , coarse coracoid exostosis of the upper anterior margin C ₄ , lip-shaped thickenings of the C ₅ appendage _{on the} right. With maximum flexion, the antelisthesis does not change. Conclusion: condition after an injury to the cervical spine; post-traumatic fixed body antibody C ₃ , osteochondrosis C _3-7 III century, deforming spondylosis C _3-4 .

09/23. the patient underwent trial cervical traction under REG - monitoring with the determination of the amplitude of the pulse blood supply in the vessels of the IHD (Fig. 3). With optimal traction parameters with a traction force of 1.5-2.0 kg and a vector of 15 ^o forward, there was an increase in the amplitude of the pulse wave in the O-M lead (vertebral-basilar pool) from 0.094 to 0.12 Ohm (by 27.7%) on the right and from 0.045 to 0.07 ohms (55.6%) on the left; the asymmetry coefficient between the parties was 124%. When changing the thrust vector to 15 ^o forward and 10 ^o to the right, the amplitude of the pulse wave was 0.14 Ohms (an increase of 49% of the original) to the right and 0.11 Ohms (an increase of 144% of the original) to the left, the asymmetry coefficient decreased to 27, 3% After removal of the cargo, the reographic index remained 26.6% higher than the original on the right and 44.4% on the left; RI = 0.12 Ohm on the right and 0.065 Ohm on the left. The asymmetry coefficient amounted to 84.6% (initially - 109%).

The patient underwent balneotherapy (carbon dioxide mineral baths 10), physiotherapy (diadynamic currents to the projection of the vertebral artery 6) and traction of SHOP during OPT 15 ^o forward and 10 ^o to the right with a traction force of 1.5-2.0 kg 12. As a result of the therapy, it was reduced dizziness, decreased frequency and intensity of craniocervicalgia, no paroxysmal conditions were noted. However, there remains a feeling of "heaviness", discomfort in the SHOP.

 After the course of treatment according to the REG data, an increase in pulse blood supply occurred - in the hemispheres by 10.4% on the right and 20% on the left (RI = 0.138 Ohm and 0.12 Ohm, respectively), in the vertebral-basilar system - by 17% on the right and 53 , 3% on the left (RI = 0.11 Ohm and 0.069 Ohm, respectively). The asymmetry coefficient between the PBC parties decreased by 35% and amounted to 73.9%.

 At discharge: pulse - 68 rpm, satisfactory properties, BP 120/70 mm RT. , temporal AD-70 mm Hg (d = s). Neurologically - painful vertebrogenic symptoms, vestibulo-atactic manifestations were reduced. It is written out with improvement (objectively), a significant improvement (subjectively).

EXAMPLE 2
B-naya S-va, 47 years old, nurse, medical history 82, was treated from January 22 to February 12, 2000 with a diagnosis of chronic cerebrovascular insufficiency according to the type of discirculatory encephalopathy of the second stage, mainly in the vertebral-basilar system, with transient ischemic attacks in the same pool; extravasal compression-irritative effect on the vertebral arteries, anomaly of the craniocervical junction, osteochondrosis C _4-5 III-IV st, uncovertebral arthrosis C _4-6 ; vertebrogenic craniocervicalgia; arterial hypertension type II GB Art., including regional cerebral.

 Received complaints of headaches, dizziness, including when turning the head, nausea, instability when walking, discomfort in the cervical spine and muscles of the shoulders, irritability, sleep disturbance, decreased memory.

 A history of a long time pain in the craniocervical junction, since 1996 - systemic dizziness, diplopia, nausea with tilts and turns of the head, episodes of increased blood pressure to 270/150 mm Hg and the gradual development of the above symptoms. Hospital treatment was repeatedly performed (vasoactive, metabolic drugs, diuretics), with an unstable positive effect up to 2-3 months.

 Upon admission to the neurological department of the Kislovodsk clinic: pulse -74 per minute, satisfactory properties, blood pressure 140/80 mm Hg, temporal blood pressure - 100 mm Hg on the right, 70 mm Hg on the left.

Movements in the cervical spine are limited: turning to the sides - up to 45 ^o , back - up to 10 ^o . Soreness of paravertebral points of the cervical spine. Pupils narrowed, reactions to light weakened, weak convergence (d> s), nasolabial fold smoothed (d), hypesthesia of the right half of the face; labial chin reflex is revealed. Reflexes on the hands are reduced (d = s), knee reflexes are satisfactory (d = s). In the Romberg position - pronounced staggering, when performing a finger-nasal test - miss.

 According to REG - pulse blood supply in the hemispheres within the age norm (RI = 0.11 Ohm on the right and 0.13 Ohm on the left), in the vertebral-basilar system it is slightly reduced (RI = 0.06 Ohm on the right and 0.09 Ohm on the left, coefficient asymmetries-50%). During rotation tests, a decrease in pulse blood supply in the vertebral arteries was noted when turning in the same direction.

 According to Doppler ultrasound, there are signs of irritative-compression insufficiency of blood flow in the vertebral arteries.

According to x-ray of the cervical spine with tomography of the craniocervical region: asymmetric position of the tooth process and its displacement, narrowing of the joint space of the first joint of the head. Pronounced deforming unvertebral arthrosis C _4-6 . The height of the C _4-5 disc has been reduced.

 On the ECG - diffuse dysmetabolic changes, signs of left ventricular myocardial hypertrophy.

01/28. the patient underwent trial cervical traction under REG - monitoring with the determination of the amplitude of the pulse blood supply in the vessels of the IHD (Fig. 4). With optimal traction parameters with a traction force of 1.5-2.0 kg and a vector of 5 ^o forward, an increase in the amplitude of the pulse wave in the O-M lead (vertebral-basilar pool) from 0.054 to 0.08 Ohm (by 48.2%) on the right and from 0.078 to 0.11 Ohms (41.1%) on the left; the asymmetry coefficient between the parties was 37.5%. When changing the thrust vector to 5 ^o forward and 5 ^{o to the} left, the amplitude of the pulse wave was 0.1 Ohm (an increase of 85.2% of the original) to the right and 0.12 Ohm (an increase of 53.9% of the original) to the left, the asymmetry coefficient decreased to 20%. After removal of the cargo, the reographic index remained higher than the original by 20.4% on the right and 4.7% on the left; RI = 0.065 ohms on the right and 0.084 ohms on the left. The asymmetry coefficient amounted to 29.2% (initially - 44.4%).

The patient underwent balneotherapy (carbon dioxide mineral baths 10), physiotherapy (diadynamic currents to the superior cervical sympathetic nodes and the projection of the vertebral artery 9) and traction of SHOP during optic surgery 5 ^° forward, 5 ^{° to the} left with a pulling force of 1.5-2.0 kg 10. V as a result of the therapy, dizziness, nausea, and instability when walking were reduced; the intensity of craniocervicalgia, discomfort in the SHOP significantly decreased, the quality of sleep improved, the mood background was leveled out.

 After the course of treatment according to the REG data, there was a slight decrease in the pulse blood supply in the vertebral-basilar system on the left and an increase on the right (RI = 0.077 Ohms and 0.089 Ohms, respectively). The asymmetry coefficient between the PBC parties was 15.6%. In the vessels of the carotid basin, an increase in pulse blood supply increased to 0.15 Ohms on the right and 0.14 Ohms on the left (by 36.3% and 1.3%, respectively).

 At discharge: pulse - 70 per minute, satisfactory properties, blood pressure 130/80 mm RT. Art. , temporal blood pressure - d = 70, S = 80 mm Hg Neurologically - the volume of voluntary movements in the SHOP increased, pain vertebrogenic symptoms, vestibulo-atactic manifestations decreased. It is discharged with significant improvement on the part of subjective and objective symptoms.

Claims (1)

A method for the treatment of vertebrogenic insufficiency of cerebral circulation by increasing the pulse blood flow in the vessels of the vertebral-basilar basin by stretching the cervical spine from 0.5 kg at an angle of forward traction from 0 ^o to 20 ^o with an interval of 5 ^o , characterized in that they change vector of traction in the frontal plane in the presence of asymmetry of the pulse blood flow through the vertebral arteries and upon reaching the maximum blood flow with optimal traction vectors in 2 planes - sagittal and frontal, zhayut traction force at the established parameters and the thrust vector.

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