RU2239381C1 - Method for degenerative-destructive articular diseases of limbs and vertebral column - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: into area of either affected articulation or segment one should subcutaneously paraarticularly inject nitrogen oxide in gaseous state; moreover, at diseases of large articulations the volume of injected gas corresponds to 700-1000 ml, and in case of diseases of small articulations - 300-600 ml; moreover, nitrogen oxide should be introduced at periodicity of once in 2 d, about 8-10 injections/course. The present innovation considerably decreases pain syndrome, increases the freedom and volume of movements in affected articulation.

EFFECT: higher efficiency of therapy.

1 cl, 4 ex

Description

The present invention relates to medicine, namely to orthopedics and traumatology, and can be used in the treatment of osteoarthritis of the joints of the extremities, osteochondrosis of all parts of the spine, shoulder-shoulder periarthritis, polyarthritis, epicondylitis, heel spurs.

Chronic joint diseases - osteochondrosis and arthrosis - a real scourge of mankind. They begin in a person when he first gets to his feet, and develop throughout life. Remaining invisible for a long time, they develop until pain appears. Who is solving the problem?

Our compatriots are treated in 70% of cases on their own. 30% of those who have reached the doctor receive a referral to specialists. It would seem that the "arsenal" of tools to solve the problem is very substantial. This is drug therapy, and manual, and nutritional correction, and, finally, surgical intervention. However, the question of the existence of funds that can help quickly, really, tangibly, remains open.

According to the WHO, to date, patients with degenerative-destructive joint diseases occupy the first place (41.1%) in primary disability, and 47.4% of those who become disabled have completely lost their ability to work.

Degenerative-destructive diseases of the joints are among those diseases of the musculoskeletal system in which quite often it is not possible to achieve satisfactory results in both conservative and surgical treatment of patients.

Surgical treatment is aimed at eliminating pain, as a rule, after unsuccessful conservative treatment.

For the hip joint, these are:

- Suspension of the hip joint according to Voss (temporare Hangehufte).

- intertrochanteric osteotomy.

- angulation osteotomy with resection of the head.

- arthrodesis.

- arthroplasty.

- endoprosthetics.

For smaller joints (knee, ankle, elbow) - this:

- Arthrotomy with revision of the joint, removal of the synovial membrane, osteophytes, overgrown adipose tissue, in a word, all degenerated tissues that create a mechanical obstacle.

- arthroplasty.

- arthrodesis.

- endoprosthetics.

(N.V. Kornilov, A.V. Voytovich “Surgical treatment of degenerative-dystrophic lesions of the joints” RosNIIITO named after Vreden, St. Petersburg, 1997, pp. 60-250).

The disadvantages of surgical treatment are: prolonged disability, high operational risk and injuries, long rehabilitation period, unpredictable clinical effect, postoperative contracture of the joints, the impossibility of surgical treatment for severe concomitant pathology, often - the need to change the profession to a lighter or disability and disability.

For the prototype, we adopted a conservative method - complete unloading of the joint and relative peace. For this, the patient is prescribed bed rest with the patient placed on the shield, traction of the limb is carried out with the help of a load. Mechanotherapy is supplemented with medication - periarticular and intraarticular administration of novocaine, the use of muscle relaxants and iontophoresis with histamine, the introduction of hydrocortisone preparations into the joint cavity. They conduct diathermy, short-wave irradiation with small doses of x-rays. By the end of the 3rd week, therapy is supplemented with water and mud therapy, active physiotherapy exercises. Conservative treatment is carried out for 4-5 weeks, after which a gentle regimen, constant gymnastics and swimming are prescribed. If the patient’s profession adversely affects his condition, a change of profession is recommended (R. M. Tikhilov, V. M. Shapovalov “Deforming arthrosis of the hip joint”, St. Petersburg, 1999)

The disadvantages of this conservative treatment method are the extremely low efficiency, duration of the treatment process, the need for inpatient treatment with a temporary disability, the relative high cost of treatment, the need for repeated courses after 3-4 months, a weak and temporary clinical effect.

Tasks: to develop a safe, highly effective, low-traumatic, cheap and widely available method for the treatment of degenerative-destructive diseases of the joints of the limbs and spine, which allows for outpatient treatment, with good clinical effect and long-term results.

The technical novelty of the invention is a method for the treatment of degenerative and destructive diseases of the joints of the limbs and spine by introducing into the region of the affected joint or segment subcutaneously, paraarticularly nitrous oxide in a gaseous state, and for diseases of large joints the volume of gas injection is 700-1000 ml, and small - 300- 600 ml

The method is as follows:

Under aseptic conditions, after treating the injection site with a cloth moistened with 96% alcohol, using a specially designed and created device, subcutaneously, in the area of the affected joint - creating subcutaneous emphysema - in 1 dose, through a rotameter (in order to lower the gas pressure to the physiological level pressure), nitric oxide is injected in volume, ml using a normal hypodermic needle:

- paravertebral:

cervical spine 300-350

thoracic spine 450-500

lumbar spine 600-700

- paraarticular:

hip joint 800-1000

knee joint 400-500

ankle joint 300

shoulder joint 300-350

After the introduction, the needle is removed, and the injection site is pressed with cotton moistened with 96% alcohol for 1-2 minutes.

The frequency of administration is 1 time in 2 days. On a course of up to 8-10 injections, depending on the degree of the destructive process. It is characteristic that after the procedure is completed there is no need to observe any protective regime.

From 1993 to the present, we have tested this method for about 700 patients aged 45 to 85 years, not a single complication was obtained, and in 97% of cases a positive result was achieved in the form of a significant reduction (up to elimination) of the pain syndrome, a sharp increase in volume and freedom of movement in the affected joint. In 2.5% of patients, the effect of treatment was negligible (practically absent). This is due to the fact that not selective patients were taken for treatment, but also patients with an extreme degree of deforming arthrosis of the knee joints, who refused for one reason or another from the indicated arthrodesis or joint replacement. Given that the method (based on the level of information available to us) is fundamentally new, developed and tested only in our hospital and there is no possibility of a comparative analysis - patients who underwent treatment were asked to fill out a questionnaire, where everyone noted (based on subjective conclusions) the effectiveness of treatment in percentage (criteria: pain, freedom and range of motion in the affected joints). The result was the following picture: 100% effect was achieved in 38% of patients, usually aged 45-50 years. Over 70% - the effect is noted by 420 patients (50% of patients) and from 50% of efficiency and above - 15% of patients.

About 35% of patients applied for a second course of treatment after 1.5-2.5 years. Another 15% of “permanent patients” undergo repeated courses for 8 years (once every 2-3 years), which enabled us to track and analyze the long-term result of treatment and (given that the method was used as an independent, without combination with other methods treatment, both pharmacological and physiotherapeutic) - come to the following conclusions:

1. Subcutaneous administration of nitrous oxide is an independent, simple, cheap and safe method of treatment, does not cause any complications and side effects and can be used in patients of any age groups, with any associated pathology.

2. The effectiveness of this method is quite high compared to other conservative methods of treatment, which allows us to offer it as the basic method of conservative treatment of destructive diseases of the joints and spine.

3. Based on the study of long-term results (analysis of radiographs before treatment and after 8 years), it can be argued that this method of treatment helps to stop the development of the destructive process in the joints.

4. There is no need for the combined use of this method with other conservative methods of treatment (exercise therapy, massage, manual therapy, FTL) and other pharmacological agents in the presence of various contraindications in patients. For many patients, this is the way to choose.

1. Patient B., 67 years old, suffers from deforming arthrosis of both knee joints for 20 years. Repeatedly, with a frequency of 3-4 months, she underwent complex treatment in the clinic and hospital - without a tangible effect. Concerned about severe, constant pain in the knee joints, crunching during movement, restriction of freedom of movement in the knee joints. On radiographs of the knee joints - the phenomenon of deforming arthrosis 2-3 tbsp. In 1994, the patient was first treated with nitrous oxide (8 sessions of 500 ml of NO subcutaneously in the area of each knee joint). As a result of the treatment, the pains disappeared completely, and freedom of movement in the joints appeared. Remission lasted 2.5 years, until the appearance of the previous symptoms, but of a weaker intensity. The patient again sought help and was again treated with nitrous oxide (6 sessions of 400 ml of NO). Despite the reduction in the dose and the number of sessions, the pain was not disturbed for 3 years, after which, at the onset of the first manifestations of the disease, the course of treatment was carried out again, at the previous doses. And again, remission was 2.5 years. At the next treatment in 2002, a radiography of the knee joints was performed. A comparative analysis of 1994 X-ray images and 2002 images was made — the absence of disease progression was noted. X-rays are almost identical. Throughout the treatment, the patient continued to work at her previous job as a storekeeper.

2. Patient S. 54 years. By profession - a driver. For 15 years, suffers from severe lumbar osteochondrosis. He was repeatedly treated in the clinic, in the neurological department, in manual therapists, underwent sessions of physical therapy, massage, FTL, acupuncture. After treatment, the improvement lasted up to 2-3 months. It was recommended to change the profession. Complaints of pain in the lumbar spine, especially in the morning and after work. Stiffness of movements in the lumbar spine.

In 1995, a course of treatment with nitrous oxide was carried out (8 sessions of 700 ml of NO subcutaneously, paravertebrally on both sides of the spinous processes of the lumbar spine). The pain syndrome is completely stopped. Freedom of movement in the lumbar region was restored. Again, the first moderate pain appeared after 2 years. The patient again asked for treatment - targeted to conduct a second course. Six sessions of 600 ml of NO were performed subcutaneously, paravertebrally to the lumbar spine. The remission lasted 3.5 years. In 2000, the patient again addressed targeted. Control x-rays of the lumbar spine were performed, a comparative analysis was carried out with images from 1995: - no change. The patient continues to work as a driver, without experiencing discomfort.

3. Patient T. 76 years. Pensioner. Diagnosis: left-sided coxarthrosis of the 3rd degree, aseptic necrosis of the head of the left thigh. Concerned about severe pain in the hip joint, even at rest, a sharp restriction of mobility in the joint. Repeatedly treated in a hospital by traditional methods - without effect. Surgical treatment was offered, which the patient categorically refused. In 1997, a course of treatment was carried out (1000 ml subcutaneously in the area of the hip joint, NO was administered on the posterior surface), 8 sessions were conducted. The result is a sharp decrease in pain, which allowed the patient to sleep soundly and move relatively freely. The restriction of movements in the joint was preserved, but the latter became much freer. The patient seeks treatment once a year, when the intensity of the pain begins to increase.

4. Patient N. 48 years old, engineer. Diagnosis: osteochondrosis of the cervical spine. Periarthritis of the shoulder blade. Twice she underwent treatment in a clinic, was treated by a chiropractor, underwent a course of FTL, acupuncture, massage, exercise therapy. Remission lasted no more than 2 months.

In 1996, the first course of treatment was carried out (6 sessions of 300 ml of NO subcutaneously in the shoulder joint along the posterior surface and 300 ml paravertebrally in the cervical spine). The result is the complete disappearance of pain, the full range of movements in the shoulder joint. Remission lasted 3 years. In 1999, she again applied for a course of treatment with nitrous oxide. Six sessions of 250 ml of NO were performed subcutaneously in the cervical spine and in the shoulder joint. Remission - to the present.

A method of treating degenerative and destructive diseases of the joints of the limbs and spine by subcutaneous, paraarticular administration of nitrous oxide is an independent method that does not require a combination with any procedures or medicines (complex treatment) or is basic in such.

The proposed method is simple, cheap and generally available, which allows it to be used on an outpatient basis. Treatment can be carried out for patients without interruption from the production and registration of the bulletin.

The effectiveness of this method (according to the observations of 700 patients) is quite high (up to 97%) and surpasses all known conservative methods of treating this pathology both in clinical effect and in the duration of subsequent remission.

The absence of contraindications, side effects, low invasiveness of the method make it widely applicable to patients with severe concomitant pathology.

The simplicity of the design of the device for the introduction of nitrous oxide - also does not present any technical difficulties.

Claims (2)

1. A method of treating degenerative-destructive diseases of joints of the limbs and spine, including the use of medications, characterized in that nitrous oxide is injected subcutaneously para-articularly into the region of the affected joint or segment in a gaseous state, and for large joint diseases the amount of injected gas is 700-1000 ml and small ones - 300-600 ml. 2. The method according to claim 1, characterized in that nitrous oxide is administered with a frequency of 1 time in 2 days, a course of 8-10 introductions.