RU2264240C1 - Method for treating patients with vertebral osteochondrosis in combination with osteoarthrosis - Google Patents

Abstract

FIELD: medicine, physiotherapy.

SUBSTANCE: one should affect with sound EHF-radiation ranged 52-78 HHz at the density of power flow being 0.75 mcW/sq. cm at modulation depth of 100% onto area of affected hip and/or knee and/or talocrural joints for 15-20 min daily. Modulation frequency corresponds to 10 Hz, about 8-12 procedure per a course. During 1 procedure one should irradiate 10 fields, not more at impact duration for one field about 2-5 min. The innovation enables to improve zonal hemodynamics, conditions for functioning of nervous-muscular and motor apparatuses of vertebral column and limbs, achieve favorable shifts in biochemical and autonomic states and achieve regress of neuroorthopedic disorders.

EFFECT: higher efficiency of therapy.

2 ex, 6 tbl

Description

The invention relates to medicine, namely to physiotherapy.

Known methods of treating extremely high frequency (EHF) radiation manifestations of osteochondrosis of the spine and osteoarthritis [1, 2, 3], suggesting the impact of millimeter waves on the projection area of the nerve structures or affected joints. The main disadvantage of the above methods is that they are aimed at stopping only orthopedic or only neurological disorders and do not take into account the mutual structural and functional influence of pathological changes in the bone-cartilage and muscle-ligamentous formations of both large joints of the limbs and small joints of the spine, forming topographic and anatomical areas having common peripheral elements for controlling the condition and operation of the musculoskeletal system.

When evaluating the bioeffect of EHF radiation in the noise range of 53-78 GHz with a spectral noise power density of 10 ^-18 -10 ^-16 W / Hz and an integrated radiation power of 0.3-10 μW at the cellular level, accelerated proliferation of human fibroblasts is most pronounced at exposure to EHF radiation for 20 and 30 minutes [2]. The dynamics of the fibroblast regeneration process were monitored with the help of cells labeled with bromodeoxyumdine embedded in the DNA molecule. Thermodiagnostic methods (thermography, deep integrated radiothermometry) also made it possible to register an increase in heat transfer processes in humans and animals with this method of exposure, which indicates an improvement in microcirculation.

There is a method of treating patients with degenerative diseases of the joints and spine by irradiation with electromagnetic waves with the combined use of various ranges, for example, EHF and laser radiation without dose differentiation and radiation parameters [3]. In this method, the therapeutic effect of EHF-therapy (when using a fixed wavelength of 5.6 mm) and the prevention of exacerbations during the treatment course is achieved by complementing it with either intensive (4-8 W, up to 20 sessions) laser therapy, or by intra- and periarticular blockages hormonal drugs like Kenalog.

A known method of treating lumbar osteochondrosis, which involves increasing the therapeutic effect due to the combined effect of two radiation modes and consisting in the simultaneous exposure to continuous noise EHF radiation with a frequency of 52-78 GHz and pulsed with a wavelength of 7.1 mm at a pulse frequency of 9-10 Hz and Duration 1 μs for 2-4 minutes per field with a total procedure time of 10-16 minutes. However, in this method, the effect is carried out on the projection area of the affected spinal roots and the nerves emanating from them in the area of the corresponding dermatomes and it is not supposed to irradiate structures providing the stat-dynamic function of the spine and limbs, which limits the application of the above method to patients with lumbar osteochondrosis with orthopedic disorders in in the form of spinal deformities, changes in the position of the pelvis, limitation of the motor function of the spine and limbs, caused by tight mobility of joints. This method also does not include effects on the joints of the legs and muscles that provide movement in them, and therefore has limitations in therapeutic use for patients with lumbar osteochondrosis with concomitant osteoarthritis [1].

The objective of the proposed method is to improve the tolerance of treatment, increase the effectiveness of therapy through the use of low dosages of modulated EHF radiation, exposure to all structures that provide support function of the spine and joints.

The problem is achieved by exposure to EHF radiation, and the specified effect is carried out in the range 52-78 GHz with a power flux density of 0.75 μW / cm ² at a modulation depth of 100% and a frequency of 10 Hz in the area of affected arched, hip, and (or ) of the knee, and (or) ankle joints for 15-30 minutes daily for 8-12 days, and in one procedure, not more than 10 fields are irradiated with a duration of exposure to 1 field of 2-5 minutes.

A special place in the clinic of vertebral pathology is occupied by spinal deformities. Persistent vertebral deformities, which have lost their sanogenetic character, displacement of the intervertebral discs, as well as changes in the joints of the spine, are often accompanied by neurological disorders in the form of irritation or compression of the roots of the spinal cord, circulatory disorders at the radicular-spinal level. Violation of the statics, biomechanics of the spine also leads to secondary neurodystrophic disturbances in the affected muscles and joints, circulation of pain impulses and, as a consequence, chronicity of the pathological process. Along with this, joint deformities lead to a violation of the biomechanics of the spine, the formation of fibromyalgic syndrome due to a change in the position of the pelvis, and a change in the motor stereotype [4, 5]. The motor stereotype is composed of static and kinematic reactions, while the backbone is the basis of static reactions [5]. In patients with vertebrogenic lesions of the peripheral nervous system, changes in the morphofunctional organization of motor units initially occur, which cause denervation-reinnervation changes and disturbances in neurotrophic non-impulse control [6], which is possible without damage to the root, that is, as a result of reflex action on axon transport during osteochondrosis zones of neuromyofibrosis.

Vertebral-neurological conflict at the stage of rehabilitation treatment requires at the same time a therapeutic effect on both dystrophically altered spinal tissues and pathologically altered nerve elements (spinal roots and ganglia, peripheral nerves, vegetative-vascular formations) in order to eliminate the mechanical component of the etiological factor, reflex dyscirculatory disorders, swelling of the soft tissues of the spine and joints, signs of aseptic inflammation [4, 5].

At the present stage of development of medicine, effective therapy of manifestations of osteochondrosis and osteoarthrosis is impossible without the use of physical factors. Drug therapy, both general and local, is difficult due to the foci of synovitis, and its use in the form of long courses in the treatment of osteochondrosis of the spine is often accompanied by the development of inflammatory and erosive changes in the gastrointestinal mucosa. An adequate choice of a medical complex implies its pathogeneticity - a predominant effect on the structures and functional units involved in the pathological process. Recently, despite the various therapeutic measures used, there are no uniform methodological approaches to the choice of medical technologies for the treatment of neuro-orthopedic pathology. Before the formation of orthopedic neurology (vertebroneurology), clinical manifestations of the nervous system were considered only as a pathology of the nerve trunks and centers [4]. Meanwhile, it has long been clear that the sources of these manifestations are not limited to the lines of nerves, and these manifestations themselves to zones of dermis and myotomes. In the brain and spinal cord, in addition to neuronal lines of propagation of excitation and inhibition, there are neurodynamic paths that take into account geometric spatial laws. Dystonic and muscular-tonic disorders are evaluated over a wide area of the body as reflex and myo-adaptive syndromes, including motor stereotypes. The bone-ligamentous and neuromuscular structures forming the topographic-anatomical areas also have peripheral elements for controlling the state and operation of the musculoskeletal system - fields on which vertebro-neurological syndromes are played. Along with the presence of functional connections, the joints of the limbs and joints of the spine have a common pathogenesis link - a dystrophic process in the structural elements of the intervertebral disc and articular cartilage, leading to a decrease in their depreciation properties.

The method is as follows. EHF-therapy was carried out using noise radiation with a spectral width of 52-78 GHz with 10 Hz modulation of radiation with a modulation depth of 100% and a power flux density of 0.75 μW / cm ² . We used the “Stella-1” EHF-therapy apparatus (entered into the State Register of Medical Devices, State Registration No. 29/06060695 / 3755-02). The emitters were located in the projection area of the interested arcuate joints of the spine (fields 1, 2 paravertebral zones at a distance of 2 cm from the spinous processes) and on the projection of the joint spaces of the affected joints of the legs (fields 3, 4 - the front and side surfaces of the hip joints, fields 5, 6 - lateral surfaces of the knee joints, field 7 - the front surface of the ankle joint). The technique is stable when exposed to 1 field from 2 to 5 minutes with a total duration of the procedure of 15-30 minutes. In this case, irradiation of joints in the presence of contractures can be supplemented by exposure to the area of muscles that provide movement in the affected joint. The course included 8-12 procedures conducted daily.

Example 1

Patient O., 46 years old, was admitted with a diagnosis of Lumbar osteochondrosis, lumbar ischialgia on the right with muscular-tonic manifestations in the recovery stage, protrusion of L ₄ -S ₁ discs, concomitant osteoarthritis of the right hip joint without exacerbation. A history of scoliosis of the thoracic spine in adolescence, post-traumatic contracture of the right knee joint (sports injury).

In the clinic, there are neuro-orthopedic disorders in the form of scoliosis of the lower thoracic and lumbar spine of the 2nd degree, kyphosis of the lower lumbar region of the 1st degree, limitation of the volume of active painless movements of the spine (Schober test 3.5 cm) and in the right hip joint (hip abduction 60 °, flexion 50 °), hypertonicity of the paravertebral and right lumbar muscles (in the standing position 0.76-0.85 kg / cm ² ), soreness of the middle gluteus and piriformis muscles on the right, the presence of painful muscle-tendon seals in the thigh muscles (I strain wide fascia of the thigh and muscles leading to the thigh), middle gluteus, sacroiliac joint, capsule of the hip joint, hypotrophy of the muscles of the right thigh (difference with the healthy side 1.5 cm), hypotension of the muscles of the right lower leg (alone 0.33 kg / cm ² , with a maximum reduction of 0.87 kg / cm ² ), hyperesthesia in the area of dermatome S ₁ on the right to the foot, without a clear asymmetry of tendon reflexes from the legs. Symptom Lasega positive with 70 ° on the right. The strength of the muscles of the foot is preserved, a slight (up to 4 points) decrease in the strength of the quadriceps femoris. When walking spares the right leg, walking on heels and toes is not broken.

According to electromyography (EMG), a change in the amplitude of the global EMG at a maximum arbitrary voltage was revealed (a decrease in m. Quadriceps to 120 μV, an increase in m. Erector trunci to 1326 μV), a curve type (I reduced in m. Quadriceps and m. Tibialis anterior) , a decrease in the amplitude of M-responses during stimulation of the tibial and tibial nerves on the right (to 0.4-1.1 mV), an increase in the speed of an impulse along the motor fibers of the tibial nerve on the right (to 89.5 m / s).

Carrying out cardiointervalography (CIG) made it possible to register the initial hypersympathicotonia (resting stress index of 197 cu, with a wedge-orthostatic test of 263 cu).

Biochemical blood parameters before treatment: sialic acids - 2.73 mmol / l (with a norm of 1.9-2.5 mmol / l), ceruloplasmin - 442 mg / l (with a norm of 280-400 mg / l), oxyproline - 1 , 9 μg / ml (control values up to 3.0 μg / ml). A general blood test revealed an increase in ESR to 31 mm / hour, white blood cells - up to 5.7 g / l.

The patient received a course of treatment in accordance with the claimed method. The exposure was carried out by noise radiation in the range 52-78 GHz with a power flux density of 0.75 μW / cm ² at a pulse modulation depth of 100%, a modulation frequency of 10 Hz on the projection area of the arcuate joints of the 4 and 5 lumbar vertebrae on both sides, the area of the hip joint on the right (front and outside surfaces). Each field was exposed for 5 minutes.

Significant changes occurred after treatment in the neuro-orthopedic status: scoliosis of the lower thoracic and lumbar spine decreased to 1 degree, the kyphosis of the lower lumbar spine disappeared, the full volume of active painless movements of the spine (Schober test 5.5 cm) was restored and in the right hip joint (hip abduction) 80 °, flexion 70 °), the initially increased tone of the paravertebral and right lumbar muscles (in a standing position 0.57-0.68 kg / cm ² ) decreased, the soreness of the middle gluteal and piriformis muscles decreased noticeably on the right, painful muscle-tendon compaction was detected only in the muscle area, straining the wide fascia of the thigh and sacroiliac joint. The degree of hypotrophy of the muscles of the right thigh decreased (the difference with the healthy side is 0.7 cm), hypotension of the calf muscles on the right (at rest 0.44 kg / cm ² , with a maximum reduction of 0.98 kg / cm ² ). Hyperesthesia in the area of dermatome S ₁ disappeared. Lasegus's symptom is negative. The strength of the muscles of the thigh, lower leg and foot are within normal limits. The normal gait has recovered.

On global electromyograms with a maximum arbitrary contraction m. quadriceps marked increase in the initially reduced amplitude to 180 μV, a decrease in the initially increased amplitude of reduction m. erector trunci up to 870 μV, transition I of the reduced type in I as in m. quadriceps and m.tibialis anterior. The amplitude of the M-responses increased with stimulation of the tibial and tibial nerves of the right leg (to 0.9-1.7 mV), a change in speed parameters was also noted - the initially increased speed of the pulse along the fibular nerve on the right decreased to 61.5 m / s 5 procedure and up to 52.3 m / s by the end of the course of treatment.

The initially increased stress index (IN) decreased at rest to 137 c.u. by the middle of the course of treatment (the transition of hypersympathicotonia to sympathicotonia) and up to 89 cu after treatment (transition of sympathicotonia to eutonia). When clino-orthostatic test also revealed an improvement in CIG: IN decreased to 162 cu

Biochemical blood parameters after treatment: sialic acids - 2.24 mmol / L (before treatment 2.73 mmol / L), ceruloplasmin - 360 mg / L (before treatment 442 mg / L), oxyproline - 0.9 μg / ml ( before treatment, 1.9 μg / ml). Conducting a general blood test recorded a decrease in ESR from 31 to 15 mm / h, white blood cells - from 5.7 to 4.9 g / l.

Example 2

стадия II, недостаточность функции суставов I, осложненный реактивным синовитом голеностопных суставов.Patient M., 50 years old, was admitted with a diagnosis of Lumbar osteochondrosis, lumbalgia in the stage of incomplete remission. Secondary osteoarthritis of the hip, ankle joints,

stage II, insufficiency of joint function I, complicated by reactive synovitis of the ankle joints.

Upon admission, she complained of pain in the lumbar spine, severe aching and breaking pains in the hip and ankle joints, arising during movement, wearing a “starting” character, intensifying after physical exertion, prolonged standing, as well as in the evening and in the first half of the night, swelling of the ankle joints, restriction of movement in them, crunching, poor sleep (due to pain in the joints), general weakness.

From the anamnesis: pain in the spine is disturbed for about 5 years, exacerbations are associated with physical exertion, for the first time joint pain appeared more than 3 years ago after an acute respiratory infection. Outpatient treatment (non-steroidal anti-inflammatory drugs, antibiotic therapy, vitamins, compresses of medical bile, chondroprotectors) was carried out, the effect of which was regarded as a “slight improvement” and persisted for 3 months. Of the concomitant pathology, the patient was also diagnosed with static longitudinal-transverse flatfoot of the 1st degree, gallstone disease, chronic autoimmune thyroiditis, varicose disease of the lower extremities.

Objective status: increased nutrition (height 158 cm, weight 80 kg). General condition is satisfactory. The skin and mucous membranes are clean. Lymph nodes are not enlarged, painless. Heart sounds are muffled, the rhythm is correct, 76 beats / min. Blood pressure 130/90 mm Hg In the lungs, vesicular breathing, no wheezing. The abdomen on palpation is soft, painless. Musculoskeletal system: on palpation, soreness of the paravertebral zones of the lumbar spine, the projection area of the trochanter of the femur, ankle joints. Ankle joints swollen (circumference of the right ankle joint 28 cm, left - 27.5 cm). Movement in the hip and ankle joints is painful, in the ankle joints it is limited due to incomplete flexion (15 ° at a rate of 20 °) and extension (in the right ankle at 30 °, in the left - 35 ° at a rate of 45 °). When moving in the hip joints, crunching, in the ankle joints - crepitus.

Biochemical blood parameters before treatment: sialic acids - 2.61 mmol / l (with a norm of 1.9-2.5 mmol / l), ceruloplasmin - 410 mg / l (with a norm of 280-400 mg / l), oxyproline - 3 2 μg / ml (normal up to 3.0 μg / ml).

Immunological blood counts before treatment: T-lymphocytes - 36% (with a norm of 40-68%), B - lymphocytes - 34% (with a norm of 12-32%), suppression index (Tx / Tc) - 1.1 (with a norm > 2.0), immunoglobulins of class A (IgA) - 3.1 g / l (with a norm of 2.5-3.0 g / l), immunoglobulins of class G (IgG) 18.0 g / l (with a norm of 8 , 4-17.0 g / l), circulating immune complexes (CEC) - 110 conventional units (at a rate of 38-95 conventional units).

Myotonometry of the lower extremities before treatment revealed a decrease in muscle tone of the legs as at rest (anterior tibial left 0.28 kg / cm ² , right 0.25 kg / cm ² and gastrocnemius left 0.32 kg / cm ² , right 0.36 kg / cm ² ), and under tension (anterior tibial left 0.68 kg / cm ² , right 0.72 kg / cm ² and calf left 0.60 kg / cm ² , right 0.55 kg / cm ² ).

According to electromyography before treatment, an increase in the values of the speed of the impulse along the motor fibers during stimulation n was detected. peroneus (69.8 m / s on the left, 101.6 m / s on the right) and n. tibialis ant. (left 76.0 m / s and 69.8 m / s) and a significant decrease in the amplitude of the M-responses (n. peroneus left and right to 0.2 mV) and n. tibialis ant. (0.3 mV on the left, 0.4 mV on the right). Superficial electromyography at rest did not reveal spontaneous activity in the muscles of the lower leg. In the maximum arbitrary voltage mode, a pronounced decrease in the average (50-70 μV) and maximum (60-80 μV) values of the amplitude of the electromyograms was recorded in all muscles.

The treatment was carried out in accordance with the claimed method. EHF exposure was carried out by noise radiation in the range 52-78 GHz with a power flux density of 0.75 μW / cm ² at a pulse modulation depth of 100%, a modulation frequency of 10 Hz in the following zones: paravertebral in the region of the lumbar spine (on the projection area of the arched joints ), on the front and outer surfaces of the hip joints, on the front surface of the ankle joints, only 8 zones, 3-4 minutes for each, the total procedure time is 24-30 minutes, for a course of 10 procedures dispensed daily.

The patient tolerated the treatment well. Clinical manifestations of balneoreaction were not recorded. From the 3rd day of treatment, a decrease in the intensity of pain in the joints and spine during movement and at rest, a decrease in reactive synovitis, normalization of sleep, the disappearance of weakness.

At the end of the treatment course, the pains in the hip joints stopped, in the ankles significantly decreased, the phenomena of reactive synovitis disappeared (the circumference of both ankle joints is 27 cm), the range of motion of the ankle joints increased (flexion to 20 °, extension - in the right ankle to 40 °, in the left up to 45 °).

Normalization of the initially changed biochemical and immunological parameters of blood was noted: sialic acids - 2.47 mmol / l, ceruloplasmin - 391 mg / l, hydroxyproline - 1.8 μg / ml, T-lymphocytes - 44%, B-lymphocytes - 23 °, suppression index - 2.2, IgA - 2.65 g / l, IgG - 13.6 g / l, CEC - 82 conventional units

With myotonometry of the lower extremities after treatment, an increase in the initially reduced tone of the leg muscles at rest was recorded (anterior tibial left from 0.28 kg / cm ² to 0.54 kg / cm ² , from the right from 0.25 kg / cm ² to 0.48 kg / cm ² and gastrocnemius on the left from 0.32 kg / cm ² to 0.65 kg / cm ² on the right 0.36 kg / cm ² 0.70 kg / cm ² ) and under tension (anterior tibia on the left with 0.68 kg / cm ² to 1.24 kg / cm ² to the right from 0.72 kg / cm ² to 1.52 kg / cm ² and the calf to the left from 0.60 kg / cm ² to 1.38 kg / cm ² from the right 0.55 kg / cm ² to 1.44 kg / cm ² ).

Electromyography of the lower extremities after treatment revealed normalization of speed parameters for all the examined nerves (50.7-66.9 m / s) and a significant increase in the amplitude of M-responses (0.20-0.60 mV). According to surface EMG, an increase in the mean and maximum oscillations of the anterior tibial and gastrocnemius muscles was noted at a maximum arbitrary voltage (70-160 μV).

The immediate outcome of the treatment is rated as "significant improvement." Control examinations carried out by the patient after 3, 6, 9 months, found the preservation of the achieved therapeutic effect.

Treatment in accordance with the claimed method received 26 patients with neurological manifestations of lumbar osteochondrosis with concomitant osteoarthritis of the hip, knee, ankle joints. The comparison group consisted of 18 patients with similar clinical manifestations receiving EHF-therapy with a modulation frequency of 0.1 Hz (9 patients) or 1.0 Hz (also 9 patients).

The clinic of the disease was dominated by neuro-orthopedic disorders in the form of kyphoscoliosis in the lumbar spine of the I-II degree, oblique position of the pelvis, caused by asymmetric reflex tension of the lumbar and paravertebral muscles or arthrogenic asymmetry of the length of the lower extremities, the presence of muscle and tendon neurosis (table 1) , a decrease in the tone of the muscles of the legs, providing movement in the affected joints (Table 2). Dynamic disorders in the form of limiting the range of motion of the spine (recorded using Schober’s test) and large joints of the legs (as measured by the goniometer) were detected in all patients. Schober’s test revealed a limitation of spinal function to 3.0 cm (average values 4.2 ± 0.3 cm at control values of 5.7 ± 0.25 cm. Limitation of joint function of the limbs was associated with both pain syndrome (72% of patients) and with the presence of contractures (43% of patients). Reflex syndromes (lumbalgia, lumbar ischialgia) with muscular-tonic and neurodystrophic manifestations prevailed in neurological status (in 84% of patients).

I-II стадия), биохимически (проведение ревмопроб выявило повышение содержания в крови сиаловых кислот - 2,71±0,23 ммоль/л, церулоплазмина - 436±14 мг/л, оксипролина - 3,32±0,17 мкг/мл).The diagnosis of concomitant osteoarthrosis was confirmed radiographically (

I-II stage), biochemically (conducting a rheumatic test revealed an increase in blood sialic acids - 2.71 ± 0.23 mmol / l, ceruloplasmin - 436 ± 14 mg / l, oxyproline - 3.32 ± 0.17 μg / ml )

The condition of the peripheral neuromotor apparatus of the affected extremities was studied by stimulation electromyography with the determination of the amplitude parameters of evoked muscle potentials (M-responses) and the speed of impulses along the efferent fibers of the peripheral nerves (SPI _eff ), as well as surface electromyography with the study of the total bioelectric activity of the foot muscles and shins at rest and at maximum arbitrary tension. The amplitude value was determined not by maximum, but by modal oscillations, that is, those whose number is maximum. According to stimulation electromyography (ENMG), signs of axonal neuropathy n were detected before treatment. peroneus sinistra and dextra, n. tibialis ant. sinistra and dextra with an increase in the value of the SPI _eff and a pronounced decrease in the amplitudes of the M-responses during stimulation of the distal and proximal motor points of peripheral nerves (Table 3). When surface EMG was recorded in the resting mode of spontaneous activity (SPA) in the muscles of the foot (mm.extensores digitorum and mm.flexsores digitomm) and the muscles of the leg (mm.tibialis anterior and mm. Triceps surae, i.e. m.soleus and two heads m.gastrocnemii) has not been identified. In the maximum arbitrary voltage mode, a roughly pronounced decrease in the amplitudes of the electromyograms was determined in all muscles, which was determined by both maximum and modal oscillations (Table 4).

When assessing the state of peripheral hemodynamics by rheography, the prevalence of the angiospastic type of vascular reactions was revealed in 62% of patients: the rheographic index (RI) was reduced (the minimum value was 0.003 Ohms at the control 0.07 ± 0.01 Ohms), the elastic modulus (MU) was increased (to 27.6% at control values of 11.7 ± 0.3%). The dicrotic index (DIC) was significantly increased: the maximum value of the indicator was 96.5% (in the control group, DIC = 38.2 ± 1.6%). In 72% of patients with the angiospastic type, an increase in the diastolic index (DSI) to 88.9% was observed (in the group of healthy DSI = 48.9 ± 3.40%). In 68% of patients, blood asymmetry was detected. The asymmetry coefficient ranged from 10.2% to 46.1% (in the group of healthy CA = 12.9 ± 1.3%). The normotonic type of vascular reactions was detected in 12% of patients. In 26% of patients, an initially reduced vascular tone (dilatation type of vascular reactions) was determined, which was characterized by a moderate increase in RI (to 0.035 Ohms), a decrease in the elastic modulus (to 7.6%), and a decrease in the tone of small vessels (DCI to 11.5% and DSI up to 11.9%).

Under the influence of treatment, a positive dynamics of statodynamic disturbances was observed in all patients, including spinal function (Schober test after treatment 5.2 ± 0.4 cm) and joints (for example, limitation of range of motion in the ankle joint decreased in 28% of 35% of patients - average values before treatment: flexion 13.1 ± 0.6 °, extension 35.1 ± 2.7 ° and after treatment 17.8 ± 0.9 ° and 43.9 ± 2.3 °, respectively). The most pronounced dynamics of clinical symptoms identified using the proposed method (table 1-6). Under the influence of EHF-therapy, normalization of initially changed blood biochemical parameters was noted (blood levels after treatment of sialic acids - 2.34 ± 0.15 mmol / L, ceruloplasmin - 369 ± 21 mg / L, oxyproline - 2.82 ± 0.16 μg / ml).

A positive reaction of the peripheral neuro-motor apparatus to both single and course exposure to EHF waves was noted. According to stimulation electromyography, under the influence of a single exposure to EHF radiation at a modulation frequency of 10 Hz, the amplitude of the evoked muscle potentials increased during stimulation of distal motor points n. peroneus sinistra and dextra, 50% - with stimulation of distal motor points n. tibialis ant. sinistra and dextra. After the course of treatment, normalization of the values of the SPI _eff for all the examined peripheral nerves sinistra and dextra (Table 3) and a marked increase in the amplitude of the M-responses during stimulation of the distal and proximal motor points n were recorded. peroneus sinistra and dextra, n. tibialis ant. sinistra. According to surface EMG, in studying the bioelectrical activity of the muscles of the feet and legs, an increase in the values of modal and maximum oscillations of mm was noted. tibialis anterior and mm. gastrocnemii sinistra and dextra at maximum arbitrary voltage (Table 4).

A change in rheovasography parameters also indicates an improvement in regional hemodynamics: in patients with an initially increased tone, MU decreased to 13.4 ± 1.09%, RI increased to 0.05 ± 0.003 Ohm, DKI decreased to 63.9 ± 11.0%, DSI - up to 69.11 ± 15.35%. In patients with an initially reduced tone, positive dynamics was also noted: MU increased to 12.5 ± 2.34, RI decreased to 0.06 ± 0.005 Ohm, DCI increased to 50.62 ± 11.09%, DSI - to 53.15 ± 12.58%.

Thus, EHF-noise at low-frequency (10 Hz) modulation by improving zonal hemodynamics, the functioning conditions of the neuromuscular and musculoskeletal apparatus of the spine and limbs, favorable shifts in the biochemical and vegetative status of patients with lumbar osteochondrosis in combination with osteoarthritis contributes to neuro regression orthopedic disorders.

Sources of information

1. Miryutova N.F., Levitsky E.F., Kozhemyakin A.M., Mavlyautdinova I.M. EHF radiation in the treatment of neurological manifestations of spinal osteochondrosis // Millimeter waves in biology and medicine. - 2000. - No. 4 (20). - S.30-36.

2. Polyakova A.G., Buylova T.V., Aleinik D.Ya., Kolesov S.N. et al. Comprehensive study of EHF exposure in an experiment and in the rehabilitation of patients with degenerative-dystrophic pathology of large joints // Millimeter waves in biology and medicine. - 1999. - No. 1 (13). - S. 22-27.

3. Vitoslavskaya E.B. Comparative evaluation of combined (combined with laser exposure) and isolated use of EHF-therapy in the treatment of patients with joint diseases // Millimeter waves in biology and medicine. - 1999. - No. 1 (13). - S. 42-43.

4. Popelyansky Y. Yu. Topographic and anatomical lines and regions in orthopedoneurology (on the example of the gluteal region) // Vertebroneurology. - 2000. - No. 1-2. - S.83-86.

5. Ivanichev G.A. Manual therapy // Manual, atlas. - Kazan, 1997 .-- 448 p.

6. Khabirov F.A. Neural-muscular trophic disorders in vertebrogenic diseases of the nervous system // Vertebroneurology. - 1998. - No. 1-2. - S.8-13.

Table 1. The dynamics of the threshold of pain sensitivity in local algogenic zones (kg / cm ² ) under the influence of the proposed method Pain points Before treatment After treatment Muscle areas m. qudratus 1.8 ± 0.25 2.8 ± 0.61 * m. erector trunci 1.7 ± 0.34 2.6 ± 0.55 * Tendon
zones Skewer of the femur 1.4 ± 0.22 2.3 ± 0.43 * Condyle of the ankle 1.6 ± 0.17 2.5 ± 0.39 * Note: * - P <0.05.

Table 2. The dynamics of muscle tone (kg / cm ² ) under the influence of the proposed method Muscle under study At rest At maximum reduction d / l s / l d / l s / l m. erector trunci 0.87 ± 0.15 0.54 ± 0.11 * 0.96 ± 0.14 0.78 ± 0.16 m. qudratus 0.54 ± 0.12 0.40 ± 0.13 0.84 ± 0.15 0.80 ± 0.17 m. tibialis ant. 0.32 ± 0.11 0.59 ± 0.10 * 0.58 ± 0.13 1.37 ± 0.26 * m. gastrocnemius 0.29 ± 0.12 0.57 ± 0.13 * 0.60 ± 0.14 1.41 ± 0.20 * Note: * - P <0.05.

Table 3. The dynamics of indicators of stimulation electromyography under the influence of the proposed method Nerve Options Before treatment After treatment 0.1 Hz 1.0 Hz 10 Hz n perone
us A _d (mV) 0.45 ± 0.04 0.57 ± 0.11 0.87 ± 0.13 1.37 ± 0.29 * A _ol (mV) 0.49 ± 0.04 0.67 ± 0.13 1.89 ± 0.82 1.23 ± 0.25 * SPI _eff (m \ s) 64.1 ± 1.1 61.9 ± 1.3 54.7 ± 0.99 50.1 ± 1.4 n
tibialis ant. A _d (mV) 0.85 ± 0.09 1.87 ± 0.86 1.81 ± 0.34 ** 2.64 ± 0.84 * A _ol (mV) 0.39 ± 0.04 1.32 ± 0.87 0.65 ± 0.16 * 0.94 ± 0.32 * SPI _eff (m \ s) 60.1 ± 0.9 57.3 ± 3.0 52.7 ± 1.96 49.6 ± 1.9 Note: * P <0.05; ** P <0.01 compared with data before treatment.

Table 4. The amplitude values of the surface EMG maximum arbitrary muscle tension under the influence of the proposed method (μV) Muscle under study Before treatment After treatment 0.1 Hz 1.0 Hz 10 Hz mm extensores digitorum 172 ± 41 252.0 ± 38 386.0 ± 62 559 ± 38 ** mm flexsores digitorum 136 ± 44 264.0 ± 29 372.0 ± 25 624 ± 27 ** m. gastrocnemius 249.0 ± 34 278.0 ± 23 393.0 ± 56 480.0 ± 51 m. tibialis anterior 234.0 ± 45 322.0 ± 30 387.0 ± 27 575.0 ± 33

Table 5. The dynamics of peripheral hemodynamics under the influence of the proposed method. RVG parameters Angiospastic type Normotonic type Dilatation type Before
treatment MU (%) 15.1 ± 1.56 13.7 ± 3.2 8.6 ± 5.5 RI (Ohm) 0.039 ± 0.009 0.067 ± 0.009 0.123 ± 0.029 DKI (%) 50.8 ± 1.1 38.5 ± 16.1 37.4 ± 9.3 DSI (%) 48.7 ± 1.6 39.3 ± 13.5 44.4 ± 1.1 After
leche
niya 0.1
Hz MU (%) 14.6 ± 1.44 11.8 ± 2.8 8.00 ± 0.6 RI (Ohm) 0.048 ± 0.003 *** 0.075 ± 0.019 0.125 ± 0.038 DKI (%) 45.9 ± 2.9 41.1 ± 9.7 42.5 ± 11.1 DSI (%) 45.7 ± 2.2 46.5 ± 5.6 40.2 ± 10.8 1.0 Hz MU (%) 13.5 ± 1.22 14.3 ± 2.8 10.2 ± 0.87 RI (Ohm) 0.047 ± 0.021 0.064 ± 0.014 0.131 ± 0.053 DKI (%) 43.9 ± 1.1 *** 29.3 ± 20.2 34.9 ± 8.8 DSI (%) 41.5 ± 1.2 *** 28.6 ± 18.9 37.3 ± 1.9 ** 10
Hz MU (%) 12.9 ± 1.30 13.3 ± 2.7 11.6 ± 3.9 RI (Ohm) 0.061 ± 0.008 *** 0.073 ± 0.035 0.139 ± 0.043 DKI (%) 48.3 ± 5.1 39.4 ± 3.7 39.9 ± 12.4 DSI (%) 47.8 ± 3.2 38.5 ± 2.4 46.2 ± 16.5 Note: ** P <0.01; *** P <0.001 compared with the data before treatment.

Table 6. The dynamics of the CIG. Indicators Subgroups
sick Before
treatment After treatment 0.1 Hz 1.0 Hz 10 Hz IN
(cu) Hypersympathicotonia 266 ± 43.8 176.2 ± 9.7 * 192 ± 20.1 * 105 ± 55.9 * Sympathicotonia 127 ± 12.5 111 ± 15.2 107 ± 6.2 96 ± 10.6 * Aytonia 65 ± 4.6 72 ± 9.8 55 ± 4.9 58 ± 3.4 Note: * - P <0.05.

Claims (1)

A method of treating patients with lumbar osteochondrosis in combination with osteoarthrosis by exposure to EHF radiation, characterized in that the effect is carried out in the range 52-78 GHz with a power flux density of 0.75 μW / cm ² at a modulation depth of 100%, modulation frequency 10 Hz on the affected area of the arched, hip, and / or knee, and / or ankle joints for 15-30 minutes daily, for a course of treatment of 8-12 procedures, and no more than 10 fields are irradiated in one procedure with a duration of exposure to one field of 2- 5 min

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