RU2234302C2 - Method for treating coxarthrosis - Google Patents

Abstract

FIELD: medicine orthopedics, traumatology.

SUBSTANCE: one should squeeze femoral artery either from one or both sides due to pneumatic gaskets at the level of the upper femoral third being below the site of branching of deep femoral artery. One should begin from 1.5-2 min to 6-8 min since the moment of pulse disappearance below the site of squeezing. Simultaneously, one should squeeze femoral artery above the site of bifurcation at affected side for 10 sec followed by removing the squeezing for 15 sec. During the 1^st wk such squeezing is carried out every 2 h 7 times daily at 10-h-long nocturnal interval. Since the 2^nd wk duration of squeezing corresponds to 3-4 min. Since the 3d wk the number of squeezing procedures should be decreased to 3 times daily at squeezing duration with gaskets to be 6-8 min. Therapy is conducted for 3 mo, and in case of operative interference - beginning from the 10^th d after operation up to consolidation along the line of osteotomy and restoration of limb's supporting capacity. The method enables to intensify collateral circulation in area of patient's hip joint.

EFFECT: higher efficiency of therapy.

2 cl, 3 dwg

Description

The invention relates to medicine, in particular to orthopedics and traumatology. Deforming coxarthrosis is one of the most common degenerative diseases of the hip joint, which progresses rapidly and often leads to patients with disabilities at working age. Despite some success in treatment, the problem remains relevant and unresolved, which leads to the search for various methods in the prevention and treatment of it.

Literature devoted to the study of coxarthrosis proves the polyetiological nature of this disease. The impact of various conditions and factors ends with a unified pathomorphological picture, which testifies to the violation of intraosseous circulation with a decrease in blood flow below the level necessary for cell survival due to insufficient blood flow, difficulty in outflow, or a combination of these factors. Against the background of a spasm of epiphyseal arterioles, venous stasis develops, intraosseous hypertension with a gradual blockade of microcirculation in the femoral head, which leads to necrobiosis, the gradual development of destructive-sclerotic changes with cystic restructuring (Guryev V.N., 1975).

Hypertension in closed chambers of inter-beam spaces, an increase in intra-articular pressure due to concomitant synovitis leading to overstretching of the joint capsule and vessels passing through it, leads to plasmostasis and hypoxia, which create conditions for the appearance of reticular tissue at the site of the bone marrow, which is the basis for excess bone formation leading to deformations of joint-forming surfaces.

As a prototype, we adopted the "Method for the treatment of Perthes disease" (patent No. 2112446, 05/10/1998). It consists in the fact that in order to enhance blood circulation of the hip joints at the level of the middle third of the thigh, inflatable cuffs are clamped 3-4 times a day, starting from 5 seconds, and brought up to 7 minutes within a week. The treatment is carried out for two months with a repetition after 1.5-2 months.

The disadvantage of this clamping of the femoral arteries is only a gradual increase in blood pressure in the entire arterial system above clamping and the absence of selective effects on the blood flow in order to strengthen it in the system of the deep femoral artery, which mainly supplies the zone of the hip joint.

Considering that the leading in the occurrence of degenerative-dystrophic changes in the hip joint is circulatory disturbance, we have proposed a method for intensifying collateral circulation of the hip joint.

The goal is to increase the effectiveness of conservative or surgical treatment of coxarthrosis by intensifying collateral circulation.

The goal is achieved as follows. At the level of the upper third of one or both thighs, below the discharge of the deep femoral artery using pneumatic cuffs, the femoral artery is clamped from one or both sides, starting from 1.5-2 minutes and bringing within 6 weeks to 6-8 minutes from the moment of disappearance pulse below the place of clamping.

At the same time, they press the femoral artery above the bifurcation on the lesion side for 10 seconds, periodically repeating during the period of vascular compression by the cuffs, using a special device (USSR author's certificate No. 1442194). Subsequently, we eliminate the compression within 15 seconds, which contributes to the propagation of the shock wave of the arterial blood stream through the deep femoral artery. At the same time, the collateral and microcirculatory networks of the vascular bed are revealed, thereby improving the blood supply to the proximal femur, hip and pelvis. This creates the conditions for the reparative regeneration of bone-cartilaginous tissue during coxarthrosis, due to an increase in blood inflow and outflow in the affected area. Such a clamping of the femoral artery for the purpose of training collateral circulation is carried out every two hours 7 times a day with a night break of 10 hours during the week. In the next 7 days, the duration of the clamp is adjusted to 3-4 minutes. After two weeks, the number of clamps is reduced to 3-4 times. Thus, we support the functioning of the vessels of the collateral system, which leads to a significant improvement in the blood supply to the hip joint through the vessels of the joint capsule, the medial and lateral envelopes of the femoral arteries and their branches, branches of the upper and lower gluteal arteries and vessels of the lower synovial fold. Three times clamping of the femoral artery is carried out for three months, and in the case of surgical treatment - from 10 days after the operation until consolidation along the line of osteotomy and restoration of limb support ability. The treatment is repeated after three months.

The proposed technique was carried out in two groups of patients with degenerative-dystrophic forms of coxarthrosis of stages 2-3, taking into account that coxarthrosis in the stage of subcompensation and decompensation mainly requires surgical treatment. All of them received conservative treatment in the preoperative period: physiotherapy exercises, massage, paraffin baths, magnetotherapy, electrophoresis, etc.

The first (control) group included 19 patients who underwent various modifications of the intertrochanteric osteotomy of the femur.

The second group consisted of 23 patients who underwent similar interventions to the control group and, additionally, for two weeks in the preoperative period and from the tenth day after surgery, intensification of collateral circulation was performed according to the full scheme.

Analysis of clinical observations over 4 years showed that in 14 (72.8%) patients of the first (control) group, the operation yielded a pronounced clinical effect, but structural changes in the femoral head and over the acetabular region were more persistent; 8 (46%) showed no tendency to decrease cystic foci and expansion of the joint space.

In the second group, in 20 (87%) patients, along with a pronounced clinical effect - a decrease in pain, an increase in the range of motion in the hip joint, an improvement in the support function of the limb, a decrease in large and the disappearance of small racemose foci and an expansion of the joint gap were observed radiographically.

Thus, the achieved positive result of surgical treatment for degenerative forms of coxarthrosis is associated with improved microcirculation in the area of the hip joint as a result of intensification of collateral circulation by the proposed method.

To illustrate the following clinical observation.

Patient K., 49 years old, and.b. No. 3-288, was received on 05/11/98 with complaints of sharp pains in the right hip joint. Sick for about 8 years. Objectively: hypotrophy of the muscles of the thigh and lower leg. Movement in the hip joint: reduction - 0 °, abduction - 10 °, flexion - 100 °, rotational - 5 °. On the radiograph of the right hip joint: a sharp narrowing of the joint gap, marginal osteophytes, subchondral sclerosis and many cystic cavities in the femoral head and over the acetabulum.

Diagnosis: right-sided deforming coxarthrosis 2-3 stages, decompensation.

After two weeks of preoperative intensification of blood circulation, an intertrochanteric detorsion-variating osteotomy was performed, fixation with a Trotsenko-Nuzhdin plate, and a derotational gypsum dressing was applied for 1.5 months. From 10 days after the operation, blood circulation intensification was continued according to the given scheme.

Support ability recovered after 6 months. The metalwork is removed after a year. When viewed after two years, complaints of minor pain after prolonged exercise. The range of motion increased: bending by -25 °, abduction by -10 °. On the radiograph: expansion of the joint space and complete bone remodeling at the site of the former cystic foci.

Improvement of blood supply in the area of the hip joint is due to the intensification of collateral circulation. The application of a pneumatic cuff on the thigh and compression of the great vessels leads to an increase in blood pressure above the place of compression, as a result of the transition of dynamic pressure to statistical pressure, which contributes to an increase in blood flow velocity and blood volume in collaterals, and therefore, their expansion. The application of cuffs on the opposite thigh or on the upper limbs potentiates these actions (Fig. 1). The increase in blood pressure reaches a maximum after 2-3 minutes and after 8-12 minutes begins to decline, approaching the original (figure 3, graph 1).

The simultaneous, periodically repeated clamping of the femoral artery above the bifurcation and its elimination creates a pressure difference factor, which we artificially quickly and temporarily create, which is one of the important links that contribute to the disclosure of collateral branches (Fig. 2). The increasing blood flow velocity at the same time reduces the viscosity of the blood, which also improves microcirculation.

The improvement in blood supply, confirmed by the data of puncture electrothermometry, intraosseous phlebography, dopplerography, viscometry, increases the effectiveness of treatment for coxarthrosis.

The proposed method of intensifying collateral circulation can be used to increase the effectiveness of both surgical and conservative treatment of coxarthrosis, and slow its progression, as it is pathogenetically substantiated. Treatment can be continued on an outpatient or home basis after appropriate training by a nurse, relatives or the patient himself due to the length of treatment.

Claims (3)

1. A method of treating coxarthrosis, which consists in intensifying collateral circulation in the area of the hip joint, characterized in that at the level of the upper third of one or both thighs, below the discharge of the deep femoral artery using pneumatic cuffs, the femoral artery is clamped from one or both sides, starting from 1.5-2 min and bringing to 6-8 min from the moment the pulse disappears below the place of clamping, at the same time, the femoral artery is clamped periodically repeated during the compression of the vessels by the cuffs above the bifurcation site on the affected side for 10 s, followed by elimination of compression for 15 s, in the first week such clamping is performed every two hours, 7 times a day, with a 10-hour night break, from the second week the clamping duration is adjusted to 3-4 min, from the third week the number of clamps is reduced to 3 times a day with a cuff clamping duration of 6-8 minutes. 2. The method according to claim 1, characterized in that the treatment is carried out for 3 months. 3. The method according to claim 1, characterized in that in the case of surgical intervention, treatment is carried out from 10 days after the operation until consolidation along the line of osteotomy and restoration of limb support capacity.

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