RU2281794C2 - Method of treatment of patients with traumas of peripheral nerves of extremites after surgery - Google Patents

Abstract

FIELD: medicine; neurology; physiotherapy.

SUBSTANCE: areas of exit of brachial plexus and then areas of proximal and distal points of peripheral and central appendices of peripheral nerve subject to low-intensity laser radiation 10-12 days after surgery in 40-50 minutes after therapeutic physical training in contact and to provide stability. The last area of influence is area onto which the surgical operation was made. Wavelength of influence is 0,89 mcm, impulse power is 3 to 5 W, pulse frequency 80 Hz, time of influence onto one field is 1 to 2 minutes. During one procedure no more than 6 fields can be used. Course consists of 10-12 procedures taken daily. During second step, 10-12 daily procedures are taken, which procedures are performed by means of pulse magnetic field brought into contact with skin covers along projections of nerve trunk and muscles innerved by the trunks at frequency of 30pulse/minute, inductance of 0,5 to 1,0 T during 10-12 minutes.

EFFECT: accelerated recovery processes; reduced chance of post-operational complications.

1 ex, 4 tbl

Description

The invention relates to medicine, namely to neurology and physiotherapy, and can be used to treat patients with injuries of peripheral nerves of the extremities in the early period after surgery.

Known methods of treating patients with injuries of the peripheral nerves of the extremities after surgery using in the early period of a constant magnetic field (PMF) [1] and medical effects [2]. However, these methods of therapeutic effects are insufficiently effective in restoring the affected neuromuscular apparatus, since the therapeutic effect of a constant magnetic field is weak and requires a long, repeated exposure, and the use of a large number of medications can have a toxic or allergic effect on the body [3].

Also known is a method of restoring the conductivity of affected nerves of a limb using therapeutic physical culture (LFK), pulsed magnetic field (UTI) and paired electrical stimulation (PES), which allows you to effectively restore the conductivity of damaged nerve fibers, eliminate vascular disorders, and restore limb function [4] .

The disadvantage of this method is that all stimulatory effects after surgery, namely the suture on the nerve fiber or vessel, are considered unacceptable for one month, that is, they are applicable only in the long term [5].

The task of the invention is to increase the effectiveness of treatment of patients in the early period, 10 days after surgery on peripheral nerve fibers and blood vessels.

The task is achieved by prescribing therapeutic physical culture (LFK) and exposure to low-intensity laser radiation (LLLT), used 10-12 days after surgery 40-90 minutes after LFK contact stable across several fields, starting sequentially from the exit area of the brachial plexus , then to the proximal and distal points of the peripheral and central segments of the affected peripheral nerve, ending with the site of surgical intervention, at a wavelength of 0.89 microns, pulse power 3-5 W, pulse frequency 80 Hz, exposure time per field 1-2 minutes, in one session no more than 6 fields, per course of 10-12 daily procedures, then additionally carry out 10-12 daily procedures with a pulsed magnetic field on the projection of the skin integument trunks of nerves and the muscles of the injured limb innervated by them at a frequency of 30 imp / min; induction of 0.5-1.2 T for 10-12 minutes

Therapeutic physical culture, conducted daily in the morning, activates the activity of all body functions, improving all levels of regulation and self-regulation of organs. It should be noted that in addition to this, the activity of skeletal muscles causes a change in the adaptogenic character in the myelin nerve fibers and motor nerve endings, enhances the branching of the stimulated nerve and provides innervation of the muscle fibers, and also increases the effect of the functioning of the existing capillary network and releases prostaglandins during muscle contraction, which contributes to activation of afferent endings.

Given that one of the main properties of the peripheral nerve is the ability to regenerate, i.e. restoration of not only the conduction and excitability of the nerve trunk, but the regeneration of all its functions - sensory, motor, trophic, treatment should be carried out in stages and for a long time. Early rehabilitation measures contribute to a faster restoration of lost functions and reduce the likelihood of complications. The use of laser radiation in the early postoperative period contributes to the development of analgesic, decongestant, anti-inflammatory and regenerative effects. These effects are realized due to the fact that laser radiation activates biochemical reactions increasing blood circulation, interstitial fluid exchanges and electrolytic metabolism in the cell protoplasm, thereby stimulating metabolic processes. The restoration of damaged nerve cells occurs due to an increase in the production of adenosine triphosphate, increased oxygen utilization, stimulation of the synthesis of proteins, nucleic acids, and activation of cytoplasmic enzymes. From the literature of recent years, it is known that laser radiation manifests itself as a multi-level effect, causing the appearance of excited states and conformational rearrangement of molecules, which helps stimulate the synthesis of protein, RNA, DNA, collagen, activates redox processes, changes the membrane potential of the cell and the pH of intercellular fluid, stimulates microcirculation with subsequent restoration of the affected elements of the neuromuscular system. Also, complex integrated adaptive neuro-reflex and neuro-humoral responses with activation of the immune system are stimulated.

When exposed to a low-frequency pulsed magnetic field, the speed of the pulse along the nerve fibers increases, their excitability increases, the function of the autonomic nervous system normalizes, the neural swelling decreases, local blood flow is activated, regeneration and myelination processes are stimulated, nerve conduction is restored, as well as impaired blood and lymph circulation. Thus, the magnetic field in a pulsed mode has a decongestant, neuromyostimulating, analgesic and trophic effect.

To achieve a positive result, it is necessary to carry out the proposed sequential appointment of procedures in the specified complex and ensure the claimed time interval. Consistent use provides activation of neuromuscular structures, which helps to accelerate the conduction of an impulse along nerve fibers and restore lost functions. The proposed 40-90 minute interval is explained by the presence of a period of aftereffect during which it is undesirable to assign any physical factors in order to avoid disruption of the achieved compensation.

For a better understanding of the essence of the method, we offer a specific example.

Patient G., 21 years old, was admitted to the hospital with a diagnosis of post-traumatic neuritis of the median, ulnar and radial nerves on the right. Syndrome of complete violation of conduction along the ulnar and partial violation of conduction along the radial and median nerves. Severe restriction of movements. Condition after plastic surgery of the brachial artery and plastic of the radial and ulnar nerves, endoneurolysis of the median nerve.

Before admission to the clinic, antibiotic therapy, degitration therapy, and vascular therapy were performed in the first 10 days after surgery. In the neurological status, the symptoms of damage to the ulnar, radial and median nerves.

Prior to treatment, patient G. underwent a clinical electrophysiological examination: stimulation electroneuromyography (SENMG) necessary to identify the level and nature of damage to neuromuscular structures. The amplitudes of the M responses and the rate of impulse conduction (SPI) were determined from the efferent motor fibers of the median, ulnar, and radial nerves (Table 1). Based on the results, treatment was performed.

The treatment regimen: at the first stage in the morning, exercise therapy was prescribed and then after 40 minutes they were exposed to low-intensity laser radiation (LLLR) contact stably in several fields, starting sequentially from the exit area of the brachial plexus, then to the proximal and distal points of the peripheral and central segments of the injured nerve, ending place of surgical intervention. The wavelength used is 0.89 μm, the pulse power is 5 W, the pulse frequency is 80 Hz, the exposure time per field is 1 min, in one session no more than 6 fields; on a course of 10 daily procedures. Then, at the second stage, 10 daily procedures were carried out using a pulsed magnetic field contacting the skin, according to the projection of the nerve trunks and the muscles innervated by them at a frequency of 30 imp / min; induction of 1.2 T for 10 minutes

After treatment by the claimed method, the patient revealed a positive dynamics of clinical indicators (Table 2) and the restoration of the functional parameters of the neuromuscular apparatus (Table 1) of the affected nerve fibers was recorded. Namely, there were absent amplitudes of the M-response and SPI indices for the ulnar, median nerves, there was a tendency to an increase in amplitudes and normalization of speed parameters along the radial nerve.

The claimed method was treated 29 people, the control group consisted of 12 people (table 3, 4) with injuries of the upper extremities after surgical interventions that received physiotherapeutic treatment in a later period. In patients treated by the claimed method, compared with the control group, significant improvement and improvement was observed 45.4%, without changes 4%.

Thus, clinical trials have shown that the inventive method provides a good therapeutic effect, accelerating recovery processes and reducing the likelihood of complications due to the early and combined effects of laser therapy and magnetostimulation.

The method is well tolerated by patients, no adverse reactions have been identified. Contraindications are common for physiotherapy.

Information sources

1. Shiman A.G., Saykova L.A. Physiotherapy of diseases of the peripheral nervous system. - St. Petersburg, 2001.

2. Gurlenya A.M., Bagel G.V. Physiotherapy and balneology of nervous diseases. - Minsk, 1989 .-- 398 p.

3. Antonov I.P., Titovets E.P. and others. To the problem of the experimental study of pathophysiological and metabolic changes in the pathology of the peripheral nervous system. Issues of the pathogenesis of trophic disorders in acute nerve trunk injury and the effectiveness of their complex treatment in the experiment (Message Eighth) // Peripheral Nervous System. - Minsk, 1984. - Iss. 7. - p. 5-22.

4. Levitsky EF, Strelis LP, and others. A method for the treatment of patients with peripheral nerve injuries after prolonged immobilization. Patent for invention No. 2185202.

5. Zhulev N.M., Shiman A.G. Electrical stimulation of neuromuscular structures in neuropathies. Method. recommendations. - L., 1991.

Table 1
The dynamics of electroneuromyographic parameters in the treatment of patient G. of the claimed method nerve Lokteva Median Ray Options Before treatment After treatment Before treatment After treatment Before treatment After treatment A. dist. μV abs abs abs 0.015 0.4 0.6 A. cf. μV abs 0.125 abs 0.15 0.2 one A.prok. abs 0.5 0.06 one 0.6 one μV AIDS m / s abs 55 abs 60 96.2 125 SPIR abs 91.3 11.3 one hundred 114.3 64 m / s table 2
Evaluation of the effectiveness of treatment of patient G. of the claimed method Indicators Before treatment After treatment Pain in hand Expressed, Permanent Appear during exercise Restriction of movements in the city .: 1. Elbow flexion 40 deg. 30 deg. 2. Extension in the elbow joint 110 degrees 150 deg. 3. Flexion of the main phalanges of the fingers Absent in all fingers Appeared in 2, 3.4 fingers Brush Strength (kg) 0 four Sensory disorder Brush Anesthesia Preserved in the suture area, brush hypesthesia

Table 3
Comparative effectiveness of the dynamics of the functional parameters of electroneuromyography in patients with demyelinating, post-traumatic neuropathies (M ± m) The ulnar nerve (the claimed method) n = 29 A dist. (ΜV) A cf. (μV) Ave. (ΜV) SPID. (M / s) SPIP. (M / s) Before treatment 0.740 ± 0.147 0.603 ± 0.152 0.673 ± 0.139 52,730 ± 3,034 39,860 ± 4,167 After treatment 0.629 ± 0.114 0.725 ± 0.139 0.687 ± 0.190 54.140 ± 4.69b 58.640 ± 5.696 ^* The ulnar nerve (fizioter. Way) n = 12 Before treatment 0.616 ± 0.216 0.720 ± 0.291 0.288 ± 0.083 44,725 + 5,993 50,000 ± 2,845 After treatment 1,240 ± 0,500 1.433 ± 0.984 1,075 ± 0,541 51,993 ± 7,752 ^* 52,787 + 4,518 Median nerve Before treatment 0.396 ± 0.100 0.319 ± 0.032 0.461 ± 0.0b2 53,289 + 2,799 48,27814,943 After treatment 0.557 ± 0.100 * 0.498 ± 0.049 * 1,021 ± 0,321 58,411 ± 3,592 60,033 ± 4,728 (the claimed method) n = 29 Median nerve Before treatment 0.766 ± 0.282 1.103 ± 0.281 0.633 ± 0.273 57.975 ± 4.538 55.150 ± 8.950 After treatment 0.770 ± 0.287 0.933 ± 0.186 0.883 ± 0.342 58.875 ± 5.592 55,450 ± 5,450 (fizioter. way) n = 12 P 0.05 differences between before and after treatment of the proposed method and prototype Table 4
Comparative effectiveness of the dynamics of clinical indicators (“disappeared” or “decreased”) in patients with injuries of nerves of the extremities (%) Complaints Swelling burning numbness pain Motion restriction Portotype before treatment n = 12 50,000 + 10,911 50,000 + 5,455 79,545 + 7,399 61,364 + 7,807 73,077 + 7,732 Portotype after treatment n = 12 17.857 + 8.988 ^* 21,492 + 8,502 ^* 43.182 + 8.320 * 29.545 + 9.426 ^* 46.154 + 8.419 ^* The inventive method n = 29 before treatment 55.882 + 5.041 53.846 + 7.929 49,000 + 3,674 51,190 + 5,311 63,043 + 4,681 The inventive method n = 29 before treatment 7.353 + 2.848 * 21.615 + 6.740 ^* 23,000 + 3,512 ^* 14,286 + 5,051 ^* 40,217 + 4,905 P 0.05 differences between before and after treatment of the proposed method and prototype

Claims (1)

A method of treating patients with injuries of the peripheral nerves of the extremities after surgery by conducting physical therapy and exposure to low-intensity laser radiation, characterized in that low-intensity laser radiation is affected 10-12 days after surgery, 40-90 minutes after physiotherapy exercises contact stably several fields, starting sequentially from the area of exit of the brachial plexus, then to the proximal and distal points of the peripheral and central segments of the peripheral nerve, ending with the site of surgical intervention, at a wavelength of 0.89 microns, pulse power 3-5 W, pulse frequency 80 Hz, exposure time per field 1-2 minutes, in one session no more than 6 fields, per course 10 -12 daily procedures, then at the second stage 10-12 daily procedures are carried out using a pulsed magnetic field on the skin integrally, on the projection of the nerve trunks and the muscles innervated by them at a frequency of 30 imp / min; induction of 0.5-1.2 T for 10-12 minutes