RU2263491C1 - Method for treating deforming arthrosis of knee joint - Google Patents

Abstract

FIELD: medicine, physiotherapy.

SUBSTANCE: one should apply a cryo-applicator onto area of affected knee joint to conduct cryo-therapy. Then at 10-15-min-long interval one should affect with high-intensity magnetic field. During acute phase of the disease mentioned at exacerbation of chronic osteoarthrosis and at complication presented by synovitis it is necessary to perform cryo-impact at -7 - -10 C for 9-11 min, the impact with high-intensity magnetic field should be performed at amplitude of magnetic induction being 800-1100 mTl and interval between impulses being 20 msec for 9-11 min. In sub-acute synovitis-free phase one should perform cryo-impact at -4 - -6 C for 7-9 min and amplitude of magnetic induction being 1100-1400 mTl, the interval between impulses being 60 msec, the time for magnetic field impact corresponds to 9-12 min. One should carry out 1 procedure daily, therapy course consists of 7-8 procedures. The innovation in question improves remote results of therapy conducted.

EFFECT: shortened terms of therapy.

7 ex

Description

The invention relates to medicine, namely to traumatology and orthopedics and physiotherapy, and can be used in cryomagnetotherapy in the treatment of patients with deforming osteoarthritis of the knee joint.

Known methods for the treatment of osteoarthritis of the knee, which include exposure to cold on the affected knee, as well as methods of treatment that combine exposure to cold and physical factors, such as cryoamplipulse therapy, cryo-CHENS therapy, cryo-ultrasound therapy, but due to the lack of effectiveness and duration ongoing treatment requires the search for more effective methods.

As a prototype for the closest technical essence, we have chosen a method for treating osteoarthritis of the knee joint, based on the combined use of cryotherapy and a magnetic field (Grigoryeva V.D., Suzdalnitsky D.V., Fedorova N.E. New approaches to the use of physical factors in the practice of medical rehabilitation of patients with osteoarthritis, for example, balneology, physiotherapy, and lay down physical education, 2000, No. 1).

For carrying out cryotherapy procedures, the authors of this method used hydrophilic gaskets used for galvanization. The gasket area is from 120 to 200 cm ² , the specific heat is from 2 to 10 KJ. The gaskets were moistened with tap water, squeezed and placed for 2-4 hours in the freezer of the refrigerator at a temperature of -12 - -15 ° C. Two cryopads of the same size were located locally in the area of the affected joint and fixed with a tight bandage. The temperature of cryopads on the skin surface at the beginning of the procedure ranged from 0 to + 4 ° C and by the end of the procedure increased to + 4 + 7 ° C. The duration of the cryotherapy procedure was 10-15 minutes. Then, with an interval of 10-15 minutes, the joint was exposed to a continuous low-frequency variable magnetic field, the magnitude of the magnetic induction was 27-35 mT, the exposure time was 15-20 minutes.

However, according to our observations, when applying the cryotherapy parameters + 4 + 7 ° С, which are proposed by the authors of the method mentioned above, the analgesic and anti-inflammatory, decongestant action is unstable and mild, patients did not notice significant changes after a course of treatment consisting of 10-15 procedures. The use of a continuous low-frequency alternating magnetic field of the indicated parameters in the treatment of osteoarthritis of the knee joint has low efficiency due to the duration of treatment, a slight decrease in pain symptom, insufficient increase in range of motion, and other objective indicators, as well as unstable remission.

The objective of the invention is to increase the effectiveness of the treatment by reducing the timing of the restoration of impaired function of the knee joint, reducing the time of inpatient treatment, as well as improving long-term treatment results.

The problem is solved in that a cryoapplicator is applied to the area of the affected knee joint and cryotherapy is carried out, after which they are exposed to a high-intensity magnetic field with an interval of 10-15 minutes, and in the acute phase of the disease with exacerbation of chronic osteoarthritis and with complications of secondary synovitis, cryotherapy is carried out at a temperature of -7 - -10 ° C for 9-11 minutes, and exposure to a highly effective magnetic field is carried out with an amplitude of magnetic induction of 800-1100 mT and an interval between pulses of 20 ms for 9-11 minutes; in the subacute phase without synovitis, cryotherapy is carried out at a temperature of -4 - -6 ° for 7-9 minutes, and the amplitude of the magnetic induction was 1100-1400 mT, the interval between pulses was 60 ms, and the exposure time of the magnetic field was 9-12 minutes. 1 procedure per day. The course of treatment is 7-8 procedures.

The essence of the invention is the development of cryomagnetotherapy parameters for highly effective treatment of deforming arthrosis of the knee joint. When applying a high-intensity pulsed magnetic field due to the large values of magnetic induction, an effect on deeply located nerve, muscle, and bone structures of the knee joint is achieved, microcirculation and regeneration of damaged tissues of the knee joint are improved. Using the indicated parameters of cryotherapy, the fastest and most stable analgesic effect is achieved, and the range of motion is increased in the knee joint, as well as the rate of metabolic processes.

Example 1

Patient B., 65 years old.

Case history No. 5084

Diagnosis at admission: deforming arthrosis of both knee joints 2-3 degrees, complicated by secondary synovitis. Concomitant pathology: coronary heart disease, cardiosclerosis, hypertension 2 tbsp., Varicose veins of the lower extremities.

From the anamnesis, it is known that a 10-year-old patient was unsuccessfully treated with various methods (drug therapy, laser therapy, drug electrophoresis of various drugs, ultrasound treatment, mud therapy, hydrogen sulfide baths, etc.) in a polyclinic, various sanatoria, at the Institute of Traumatology and Orthopedics named after Harmful. According to the patient, no positive effect from the treatment was observed, and she was offered an operation for knee joint endoprosthetics, since she could move independently with very great difficulty and needed constant help.

Upon admission, the patient complained of intense pain at rest and during movement, limitation of range of motion.

On the radiograph of the phenomenon of deforming arthrosis 2-3 tbsp.

Objectively: the pain score is 3 points, the articular index is 3 points, the swelling index is 2 points, the range of motion is 3 points.

Data from laser Doppler laser fluometry: on the lower extremities, regional vascular resistance is increased, capillary blood flow is reduced. CC in the region of the right and left knee joints is 1.40 on the right leg and 1.60 on the left. Regional vascular resistance in the region of the right knee joint is 69.05, in the region of the left - 60.42.

The patient received treatment according to the proposed method of cryomagnetotherapy for the treatment of acute deforming arthrosis of the knee joint without the use of drugs and any other therapy.

Cryotherapy was carried out by applying cryoapplicators to the area of the affected knee joints with an exposure temperature of -10 ° C, an exposure duration of 11 minutes, then after 15 minutes a high-intensity magnetic field was applied with an amplitude of magnetic induction of 1100 mT, intervals between pulses of 20 ms and an exposure duration of 11 minutes. The course was 8 procedures. After the first procedure, the patient noted a decrease in pain. By the third procedure, according to the patient, her condition improved significantly. The procedures were well tolerated despite the presence of concomitant pathology, in contrast to the previous treatment with other physical factors, after which a deterioration was noted. After the treatment according to our proposed method, the pain score is 1 point, the articular index is 1 point, the swelling index is 1 point, the range of motion is 2 points. The length of stay in the hospital is 16 days.

Laser Doppler fluometry data: on the lower extremities, capillary blood flow in the region of the right and left knee joints 1.80, regional vascular resistance - 52.78 on both joints, that is, there is an improvement in capillary blood flow and a decrease in regional vascular resistance after treatment. The length of stay in the hospital was 20 days.

After the treatment, the patient began to walk without assistance. After 1 year, the patient was admitted to a second course of treatment. Over the course of the year, she felt good, began to move more. She turned to treatment for the prevention of the condition in which she first entered.

This example shows that our method of treatment is highly effective even in very severe cases with poor tolerance of other types of treatment, in the presence of concomitant pathology, as well as in old age.

Example 2. Patient F. 67 years old and / b No. 1690

Diagnosis at admission: deforming arthrosis of the right knee joint 2-3 degrees, acute phase, the presence of secondary synovitis. Concomitant pathology: hypertension 1-2 degrees, cardiosclerosis, gastroduodenitis.

From the anamnesis it is known that for the last 2 years the patient underwent drug treatment, laser therapy. According to the patient, no significant improvement occurred.

At admission, the patient complained of pain at rest, as well as during movement, limiting the amplitude of movements in the right knee joint. On the radiograph of the phenomenon of deforming arthrosis of the right knee joint of 2-3 degrees. Objectively: pain score - 3 points; articular index - 2 points; swelling index - 3 points; limitation of the amplitude of movements - 3 points. Data from laser Doppler laser fluometry: on the right lower limb, regional vascular resistance is increased, capillary blood flow is reduced.

Regional vascular resistance in the region of the right knee joint - 67.17; in the left area - 54.66.

The patient was prescribed a course of treatment according to the claimed method in the acute stage without the use of medication and any other therapy. The course was 8 procedures. Cryotherapy was carried out by applying a cryo applicator frozen to -9 ° C to the area of the right knee joint, the duration of cryotherapy was 10 minutes, then after 12 minutes they were exposed to a high-intensity magnetic field with a magnetic induction amplitude of 1000 mT and intervals between pulses of 20 ms with a duration of 10 minutes.

After the treatment on the right knee joint, the pain score is 1, the articular index is 1, the swelling index is 1, the range of motion is limited to 1. The length of hospital stay is 14 days. Inspected after a year. It walks freely, moderate pain in the right knee joint appears after exercise. The result is rated as good.

Example 3

Patient S. 50 years. and / b No. 3018

Diagnosis at admission: deforming arthrosis of the left knee joint 1-2 degrees. Concomitant pathology: IHD, gastroduodenitis.

The patient was admitted with complaints of pain in the left knee joint at rest and during movement, limiting the amplitude of movement within 10-15.

Objectively: the pain score is 2 points, the articular index is 2 points, the swelling index is 2 points, the range of motion is limited to 2 points. The course of treatment according to the claimed method amounted to 7 procedures. Cryotherapy was carried out by exposure of the cryoapplicator frozen to -7 ° C to the left knee joint for 9 minutes, after which 10 minutes they were exposed to a high-intensity magnetic field with a magnetic induction amplitude of 800 mT, intervals between pulses of 20 ms, and the exposure time was 9 minutes. After the treatment, the pain score is 0 points; articular index - 0 points; swelling index - 1 point; limitation of the amplitude of motion - 0 points;

When discharged after 2 weeks, walks freely, without pain, movement in the joint without restriction. Inspected after a year. The result is good.

Example 4

Patient P., 52 years old. and / b No. 3970

Diagnosis at admission: deforming arthrosis of the left knee joint of the 1st degree

Upon admission, the patient complained of pain when walking up the stairs and when traveling by car, as well as when the weather changed. On the roentgenogram of the phenomenon of DOA 1 - degree. Objectively: the pain score is 1 point, the articular index is 1 point, the swelling index is 1 point, the limitation of the amplitude of movements is 1 point.

A method of treatment by cryomagnetotherapy was as follows. A cryoapplicator frozen to -4 ° C was applied to the area of the affected joint, exposure duration 7 minutes. After that, after 10 minutes, a high-intensity magnetic field was applied, the amplitude of magnetic induction was 1100 mT with an interval between pulses of 60 ms, and the time of exposure to the magnetic field was 9 minutes.

The procedures were well tolerated. Improvement was noted after the first procedure. In total, the patient underwent 5 procedures, after which he was discharged from the hospital in connection with a significant improvement.

After the fifth procedure, the pain score is 0 points. The articular index is 0 points, the swelling index is 0 points. The limitation of the amplitude of motion is 0 points. The length of stay in the hospital is 12 days. 4 months after treatment, the pain was not disturbed.

This example shows that in the subacute stage of DOA of the 1st degree in middle-aged people, it is possible to shorten the treatment time to 5 procedures.

Example 5

Patient B. 45 years. and / b No. 2001

Diagnosis at admission: deforming arthrosis of the right knee joint of the 2nd degree.

At admission, the patient complained of pain while walking, limiting movements in the right knee joint - 5-10.

Objectively, the pain score is 2 points, the articular index is 2 points, the swelling index is 2 points, the range of motion is limited to 2 points. On the roentgenogram of the phenomenon of deforming arthrosis of the 2nd degree.

According to the claimed method carried out 6 procedures without the use of drugs and any other therapy. Cryotherapy was carried out by applying a cryoapplicator frozen to -5 ° C to the area of the right knee joint, the duration of cryotherapy was 8 minutes, then after 12 minutes they were exposed to a high-intensity magnetic field with an amplitude of magnetic induction of 1200 mT and intervals between pulses of 60 ms with a duration of exposure of 10 minutes.

After the treatment, the pain score is 0 points, the articular index is 0 points, the swelling index is 0 points; limitation of the amplitude of movements - 0 points. After treatment when walking pain does not notes. Full range of motion in the knee joint. Duration of hospital stay - 12 days.

Example 6

Patient A. 60 years old And / No. 4980

Diagnosis at admission: deforming osteoarthritis of the right and left knee joints in the subacute stage without synovitis.

Upon admission, the patient complained of pain when walking and at rest.

Objectively: the pain score is 2 points, the articular index is 2 points, the swelling index is 2 points, the amplitude of movement is limited to 1 point.

The patient underwent 6 procedures according to the claimed method. Cryotherapy was carried out by cryo applicators frozen to -6 ° C on the area of both knee joints, the duration of cryotherapy was 9 minutes, then after 15 (or 14 minutes) they were exposed to a high-intensity magnetic field with a magnetic induction amplitude of 1400 mT, the interval between pulses was 60 ms and the time of exposure to the magnetic field 12 minutes After the course of treatment, the pain score is 0 points, the articular index is 0 points, the swelling index is 1, the amplitude of movement is limited to 0 points. When discharged after 12 days, walks freely, without pain, movement in the joint without restrictions. Inspected after a year. The result is good.

Example 7

Patient T. 62 years old and / or No. 1139

Diagnosis at admission: deforming osteoarthrosis of the right knee joint. The patient was admitted with complaints of pain in the knee joint at rest and during movement. The pain has been disturbing for 3 years, only medication has received treatment.

Objectively, the pain score is 2 points, the articular index is 2 points, the swelling index is 2 points, the range of motion is 2 points, the Doppler fluometry data is in the area of the right knee joint KK 1.6, RCC - 63.65.

On the roentgenogram of the phenomenon of deforming osteoarthrosis of 2 degrees.

The patient was treated according to the methodology that is the prototype, that is, the area of the knee joint was exposed to frozen cryopackages and a low-intensity magnetic field of the Magniter apparatus. Also, the patient received traditional treatment with non-steroidal anti-inflammatory drugs, group B vitamins. The course of treatment was 12 procedures.

The treatment was well tolerated, but the patient did not notice any significant positive changes after completing the course of therapy, she complained of pain at rest and when moving in the area of the right knee joint Objectively, the pain score was 1 point, the joint index was 2 points, the swelling index was 1- 2 points, limitation of range of motion - 2 points, Doppler fluometry data - in the area of the right knee joint, KK - 1.80, RCC - 58.33. The length of stay in the hospital was 35 days.

This example shows that the use of cryomagnetotherapy using cryopackages and a low-intensity magnetic field is not effective enough.

Under observation were 58 patients aged 47 to 74 years, 22 men and 36 women with a disease duration of 1 year to 10 years. The clinical picture was typical and was characterized by the presence of pain in the affected joints, aggravated by exertion, limitation of mobility and crunching in the joints. In 21 patients, DOA was complicated by secondary synovitis.

The control group (30 people) consisted of patients who received cryotherapy with cryopackages and low-frequency magnetic therapy against the background of standard drug therapy.

In patients who received treatment according to our proposed method, the positive dynamics were clearly expressed. Pain reduction on average occurred at the 2nd-3rd session, while in the control group - at the 7th - 9th session. A comparative study of the results of treatment by the integral indicator of SCS revealed a more preferable effect from the method we proposed. The proposed method of treatment allows to reduce the treatment time by 2-3 weeks. Early long-term results after 3 months showed a significant positive effect in all patients, after 6 months moderate pain in the knee joints appeared in 2 (3.5%) patients, and after a year - in 7 (12.1%). In the control group of patients, a moderate positive effect ranged from 1 to 3 months in 14 (46.6%) patients and up to 6 months in 2 (6.6%) patients.

57 patients from the main group returned to their previous work after 3-4 months (98.3%), 1 patient received a disability (0.7%), joint function recovered by 1-2 months. In the control group of 30 patients, 7 received disabilities (23.3%), 11 people returned to their previous work (36.6%), joint function was restored by 4-6 months in 25 patients, only in 5 patients joint function was restored to 3-4 months.

Thus, all patients had a positive effect with a good outcome by 3 months in the main group, by 56 (96.5) patients by 6 months, and by 51 (87.9%) patients by the year, while in the control group, by 3 months, a similar indicator was observed in 14 (46.6%) patients, by 6 months - in 2 (6.6%) patients, and by the year all patients had a negative result.

The proposed method of treatment allows to increase the effectiveness of treatment of DOA of the knee joint by reducing the recovery time of impaired function of the knee joint, reducing the time of inpatient treatment, as well as improving long-term treatment results.

Claims (1)

A method for the treatment of deforming arthrosis of the knee by cryomagnetotherapy, which consists in the initial cryotherapy by applying cryoapplicators to the affected knee joint, followed by exposure to a magnetic field, and magnetotherapy is carried out with an interval of 10-15 minutes, characterized in that it is affected by a high-intensity pulsed magnetic field, and the acute phase of the disease, with exacerbation of chronic osteoarthritis, with complications of secondary synovitis, the applicators are frozen to (-7) - (- 10) ° C and cryotherapy is carried out for 9-11 minutes, and exposure to a high-intensity magnetic field is carried out with an amplitude of magnetic induction of 800-1100 mT and an interval between pulses of 20 ms for 9-11 minutes, with osteoarthritis of the knee joints in the subacute phase without synovitis, the applicators freeze to ( -4) - (- 6) ° C and cryotherapy is carried out for 7-9 minutes, the amplitude of magnetic induction is 1100-1400 mT, and the interval between pulses is 60 ms, the duration of exposure to a magnetic field is 9-12 minutes, the course of treatment is 5- 8 treatments performed x daily for 1 procedure per day.