RU2207167C2 - Method for administering laser therapy - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves injecting a mixture of 1% lidocaine solution and 0.5% adrenalin solution taken in 200000:1 proportion after having accomplished surgical manipulations. Endoscopic laser radiation therapy is administered by slowly scanning the treatment area with helium-neon laser not longer than 15 min with power density of 20 mW/cm². EFFECT: enhanced effectiveness of postsurgical complication prophylaxis.

Description

 The invention relates to medicine, in particular to traumatology and orthopedics, and can be used to biostimulate the body in order to eliminate pain, inflammatory, edematous syndromes, improve local and general lymph circulation, tissue regeneration after arthroscopic surgery on the knee joint.

 A known method of endoscopic surgery on the knee joint using various additional equipment (electroresector, coagulator), significantly increasing the possibility of surgical intervention (J.M. Fox, RD Ferkel "Use of Electrosurgery in Arthroscopy Surgery" // J. Arthroscopy Surgery, 1988, McGraw -Hill Book Company, p. 315-325). However, the use of additional equipment can only facilitate the implementation of surgical techniques for endoscopic operations without additional therapeutic effects aimed at eliminating postoperative synovitis, increasing the effectiveness of rehabilitation treatment.

The prototype is the technique of intra-articular laser irradiation, which was used in patients with a primary lesion of the capsule-ligamentous apparatus of the knee joint of an inflammatory-dystrophic nature (Berglezov MA, Vyalko V.V., Ugnivenko V.I. "Invasive methods of laser therapy in traumatology and orthopedics . Methodological recommendations. ”- M., - 1995. - 21 C.) It consists of puncture of the joint with a thin needle through which the joint cavity was filled with oxygen, then the joint was punctured with a needle with a wide clearance through which Fiber optic. Under the control of a spot glowing through the skin, the light guide is brought to the affected area of the joint (upper inversion, region of the pterygoid ligament). For irradiation using the light of a helium-neon laser with a radiation power at the working end of the fiber 10-15 mW / cm ² . The procedure was repeated after 3-4 days. The total number of sessions 4-6 lasting 15-20 minutes. As a result of treatment, the symptoms of synovitis, flexion contracture were eliminated, pain was reduced, the anatomical, physiological and biomechanical parameters of the joints were normalized (sagittal instability and podkosoustoychivosti syndrome).

 The disadvantages of this method include the inability to accurately localize the location of the laser beam on the affected joint structure.

We have developed a new method of intraarticular laser therapy during endoscopic operations on the knee joint. After preliminary anesthesia, an arthroscope is inserted through the anterior external access into the joint cavity, and after performing surgical manipulations through an antero-internal sterile laser endoscope. 30-40 ml of a mixture of 1% lidocaine solution and 0.5% adrenaline solution (in a ratio of 200000: 1) is injected into the joint cavity. Under the control of the endoscope, the necessary exposure site is determined and a fiber guide is supplied to it. Laser therapy is carried out by the method of slow scanning of selected areas for 3-5 minutes for each (total time not more than 15 minutes) with a helium-neon laser beam with a power density of 20 mW / cm ² . The presence of adrenaline in the intracavitary fluid avoids bleeding, which ensures transparency of the medium for the entire period of laser exposure.

 We performed a comparative analysis of the results of external and intraarticular laser therapy in patients with degenerative-dystrophic diseases of the knee joint after surgical treatment using endoscopic techniques. Intra-articular laser therapy during surgery was performed in 22 patients. In 28 patients, external laser therapy was carried out within 7 days after the operation according to the methods developed at the institute. In the postoperative period, all patients showed a decrease in synovitis, less severe pain, rapid regression of neurological disorders and the development of joint movements compared with patients in the control group (52 patients) who received traditional conservative treatment. In a comparative analysis of clinical and instrumental (biophotometry, laser Doppler flowmetry) examination data of patients, there were no differences in the results of intraarticular and external laser therapy. Thus, targeted intraarticular laser therapy is an effective way to prevent postoperative complications of endoscopic operations on the knee joint. A single intraarticular exposure to laser light replaced a whole course of external laser therapy, which allows us to recommend it for use in arthroscopic operations.

 Clinical example.

 Bogomolets N.G., born in 1930, medical history 743. Diagnosis: Deforming arthrosis of the left knee joint, III tbsp. Complaints of pain in the joint at rest and during exercise, limitation of mobility.

 02/10/98 the patient during arthroscopic surgery underwent intraarticular targeted exposure to the resected areas of the medial condyles of the femur and tibia according to the proposed method. Postoperative cider proceeded without synovitis. In the postoperative period, the patient noted a marked decrease in the intensity of pain, an increase in the amplitude of movements in comparison with patients in the control group.

Claims (1)

A method of intraarticular laser therapy for arthroscopic surgery on the knee joint, comprising introducing into the joint cavity a mixture of 1% lidocaine solution and 0.5% adrenaline solution in a ratio of 200,000: 1 after surgical procedures and performing endoscopic laser therapy with a helium-neon laser by slowly scanning the site of exposure with total time no more than 15 min and a power density of 20 mW / cm ² .