RU2243004C2 - Method for rehabilitating pelvic bone fracture patients - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves applying fluctuating currents of complex modulation modulated with low frequencies from 57 to 10 Hz in electrostimulation cases in noise frequency bandwidth from 0.5 to 10000 Hz close to physiological frequencies. First biologically active points of Bao-liao are treated in running wave mode with amplitude modulation frequency of 0.5 Hz under current intensity set close to cause moderate asynchronous vibration effect. The hip joint muscles are stimulated on the side the injured pelvic bones are available and intact extremity side in pulsating generation modes with pause of 1:2-1:3 s and running wave of amplitude modulation frequency of 0.5 Hz being sent under current intensity reaching condition of feeble contractions of the hip joint muscles. The total treatment course is 8-15 daily procedures long. The total treatment procedure duration is 8-15 min.

EFFECT: enhanced effectiveness of treatment.

Description

The invention relates to medicine, namely to physiotherapy, and is intended for the rehabilitation of patients in the treatment of pelvic fractures.

There is a method of treating fractures using calcium and phosphorus electrophoresis with galvanic current (Mitbreith I.M., Grigoryeva V.D. Damage to support and movement organs // Balneology and physiotherapy. V.2. M: Medicine, 1985, p. 377; Kornilov V.M., Orlov A.N., Kornilova G.I. et al. Rehabilitation of patients with bone fractures // Medical Rehabilitation, Vol. 2. M. - Perm: IPK Zvezda, 1998, p. 386). Medicinal electrophoresis, which consists of the reflex and humoral effects of direct current and formological agents, has a good effect on blood circulation in tissues and increases tissue metabolism, which leads to a decrease in inflammation and pain in the area of damage.

However, the continuous nature of the supply of galvanic current leads to the occurrence of adaptation phenomena in the tissues to this current, which, in turn, reduces the reparative processes in traumatically damaged formations, in addition, the possibility of an electrical stimulation effect on the musculo-ligamentous apparatus is excluded.

There is also a method of treating fractures by forcing calcium and phosphorus with sinusoidal modulated currents - SMT (Mitbreith IM, Grigoryeva VD Damage to the support and movement organs // Balneology and physiotherapy. V.2. M: Medicine, 1985, c .377) and currents of exponential form (Kornilov V.M., Orlov A.N., Kornilova G.I. et al. Rehabilitation of patients with bone fractures // Medical Rehabilitation. T.2. M. - Perm: IPK “Star ”, 1998, c. 388).

However, SMT are not distinguished by the physiological effect on the neuromuscular and muscular-ligamentous apparatus of warm-blooded, in view of a sinusoidal or semi-sinusoidal electrical signal, not characteristic of living excitable systems (Krasnogorskaya N.V. Electromagnetic fields in the biosphere. T.1. M .: Science 1984, p. 5-11). The exponential signal is used without filling the pulses with the carrier frequency. The rectified SMT regimen and constant exponential pulses, on which the forcing and muscle stimulation are performed, are quite “rigid” and, in some cases, poorly tolerated by patients. In addition, the rhythmic effect of impulses of the same nature and current fluctuations causes a rapid onset of tissue adaptation to them, reduces positive sanogenetic changes, in particular in the treatment of pelvic fractures, i.e. reparative processes in the fracture zone are slowed down.

There is a method of rehabilitation of patients with bone fractures by exposure to the area of damage by low-frequency currents with an exponential pulse shape and a frequency of 50-80 Hz (Medical rehabilitation / Ed. By prof. V.M. Bogolyubov. T.2. M. - Perm: IPC “Star”, 1998, p. 388).

However, the regime of muscle stimulation by constant exponential current is a rather “rude” effect, the same procedure in the late recovery period does not affect the reparative processes in the fracture zone, but only helps to restore muscle tone, improves blood circulation and eliminates congestion.

The task is to optimize the conditions for reparative processes in the fracture zone by stimulating the musculo-ligamentous apparatus of the pelvic complex in the early rehabilitation period.

In the proposed method for the rehabilitation of patients with pelvic fractures by electrostimulation of muscles with low-frequency currents according to the invention, complexly modulated fluctuating currents are used in a noise frequency range close to physiological from 0.5 to 10000 Hz, modulated by low frequencies from 57 to 10 Hz, first act on the biologically active points of Balyao in the “traveling” wave mode with an amplitude modulation frequency (AM) of 0.5 Hz, with a current strength of up to moderately pronounced asynchronous vibration, then on the muscles of the hip joints from the side of damage to the pelvic bones and intact limb in the pulse generation modes with a sending-pause of 1: 2-1: 3 s, and the “traveling” wave with AM 0.5 Hz, with amperage to weak contractions of the muscles of the pelvic complex. In this case, the course of treatment is 8-15 daily procedures, and the total duration of the procedure is 8-15 minutes.

As you know, when a bone fracture occurs in the area of injury, a focus of irrigation occurs, which activates the mechanisms of reparative regeneration - the healing of a bone wound. The process of bone regeneration is a very complex interweaving of general influences at the systemic level and local changes in tissue metabolism, and, in addition, it is closely related to the environmental conditions that arise in the fracture zone (Balneology and Physiotherapy / Edited by Prof. V.M. Bogolyubov. T.2. M., 1985, p. 371).

The authors' studies showed that the impact of fluctuating currents (with the indicated parameters) on the musculo-ligamentous apparatus of the damage zone after comparing and firmly fixing fragments helps to create optimal conditions for reparative processes. With arrhythmic contractions of muscles, lost function is restored, their nervous regulation improves, blood and lymph circulation improves, enzymatic activity is activated, leukocyte phagocytic activity is increased, regeneration processes are accelerated. The electrical signal of complex-modulated fluctuating currents in a noise frequency range close to physiological (from 0.5 to 10,000 Hz) is adequate to human biological rhythms of the neuromuscular apparatus, and its modulation by low frequencies from 57 to 10 Hz ensures the complete absence of the effect of adaptation to current , which is inevitable with the rhythmic impact of pulses of the same nature. The use of fluctuating currents has an analgesic, anti-inflammatory, absorbable effect, which helps to reduce the risk of purulent inflammation in the fracture zone. Such use of electric current at the beginning of the procedure to biologically active points of Bialio in the “traveling” mode with amplitude modulation of 0.5 Hz, carried out to moderately pronounced asynchronous vibration, activates the human body and affects the muscles of the pelvic complex as a whole. Impact on the hip joint from the side of damage and on the intact limb with the indicated currents in the pulse generation mode with a send-pause of 1: 2-1: 3 s (the change in the duration of noise current pulses is performed automatically, creating a constant duty cycle of the output signal and the greatest energy characteristic of the electric pulse) and in the “traveling” wave mode with amplitude modulation of 0.5 Hz it provides electrical stimulation of the neuromuscular tissues of the pelvic region at any depth of their occurrence, stimulating the osteo eparatsii. In this case, the depth of penetration of electric current into the tissues of the musculo-ligamentous apparatus depends on the type of its modulation.

Thus, when using the proposed method in the zone of fracture of the pelvic bones, optimal conditions are created that contribute to the activation of reparative processes, and, consequently, the effectiveness of rehabilitation of patients.

The method is as follows. They use the EMIT-1 device of electropulse therapy with complex modulated fluctuating currents, manufactured by the MAGNON company, Yekaterinburg (License of the Ministry of Health of the Russian Federation No. 42 / 99-531-0808 of 05.20.99), which can work together with the traveling wave block .

Rehabilitation of patients is carried out in the early stages after a closed reposition and reliable fixation of fragments of the pelvic bones by an external fixation device. First, an electric shock is applied to biologically active points (BAP) of Ba-Liao for 1-2 minutes. To do this, special local electrodes are installed on the BAT data located in the lumbar region, not exceeding 0.5-1 cm in diameter. The number of electrodes can be from 3 to 5 and depends on the severity of the fracture. Electric current is supplied to the electrodes in the “traveling wave” mode with an amplitude modulation frequency (AM) Δ 0.5 Hz. Then, physiotherapy of the hip joints is carried out in the modes of pulsed generation and “traveling wave”, first from the side of damage to the pelvic bones, and then from the intact limb, the duration of the procedure is 6-15 minutes. For this, two plate electrodes are placed transversely on the front and rear surfaces of the hip joint and are exposed to electric current with the following parameters: frequency of the fluctuating current - 0.5-10000 Hz, modulation frequency - 57-10 Hz, pulse generation - 1: 2-1: 3 s, the amplitude modulation of the “traveling wave” is Δ 0.5 Hz, the amplitude value of the current is up to a moderate pronounced asynchronous vibration, reduced to weak contractions of the muscles of the pelvic girdle (current strength is 8-25 mA). The total duration of the procedure is 8-15 minutes. The course of treatment is daily and amounts to 8-15 procedures.

Example. Patient S. was admitted to the clinic of UNIITO with a diagnosis of a fracture of the right pubic and sciatic bones with damage to the ligaments of the pubic and right sacroiliac joints. On the 3rd day after admission, transosseous osteosynthesis of pelvic injuries by external fixation was performed. From 2 days after the operation, a course of treatment with complex modulated fluctuating currents is prescribed according to the method described above. The procedures were performed daily, the course was 10 procedures. The patient is activated on the 5th day after the operation, walking with crutches is allowed. X-ray control showed that fusion in the area of fractures and ruptures of the joints of the pelvis occurred at the optimal time by 8 weeks after the injury. Remote anatomical and functional result is good.

Claims (1)

A method of rehabilitation of patients with pelvic fractures by electrostimulation of muscles with low-frequency currents, characterized in that for electrostimulation using complex-modulated fluctuating currents in the noise frequency range from 0.5 to 10000 Hz, close to physiological, modulated by low frequencies from 57 to 10 Hz, This first affects the biologically active points of Biao, in the "traveling" wave mode, with an amplitude modulation frequency (AM) of 0.5 Hz at a current strength of up to moderately pronounced asynchronous vibration, then the hip muscles are stimulated joints on the side of damage to the pelvic bones and intact limb in the pulse generation modes with a pause of 1: 2-1: 3 s and a “traveling” wave with AM 0.5 Hz, with amperage to weak contractions of the muscles of the pelvic complex, while treatment is 8-15 daily procedures, and the total duration of the procedure is 8-15 minutes.