RU2285547C2 - Method for treating osteoarthrosis cases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves administering general hydrogen sulfide baths with hydrogen sulfide concentration of 50-150 mg/l every other day after having applied adaptation treatment. Galvanic pelotherapy is applied to reflexogenic segmental vertebral column region at bath-free days. Paravertebral zones in C5-D2 zone are treated when upper extremity articulations are predominantly injured, L1-S3 zone being treated in upper extremity cases. Then the region of one or several injured articulations is treated. The total treatment course is 8 balneo- and 8 physioprocedures long.

EFFECT: accelerated treatment course.

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Description

The invention relates to medicine, namely to rheumatology, and can be used in medical practice in the treatment of patients with osteoarthritis.

There is a method of treating osteoarthrosis (OA) by using hydrogen sulfide baths with a gradual increase in the concentration of hydrogen sulfide from 50-100-150 (mg / l) of hydrogen sulfide in combination on days free of baths with galvanopeloid therapy for two more affected joints [1].

However, the use of known methods gives a pronounced positive clinical effect on average in 86% of cases with 8% balneopathological reaction.

According to medical statistics, in recent years the number of people suffering from OA among people of the able-bodied population has increased, an increase in incidence of 25% is found. At the same time, primary disability increased by 20%, and the total number of people with disabilities in OA was 21.3 per 10,000 residents of the Russian Federation over 16 years of age. The widespread prevalence of diseases of the musculoskeletal system (up to 42%) determines the relevance of the search for methods and means of pathogenetic therapy, especially non-pharmacological ones.

Peloid therapy is one of the active physical methods that have a beneficial effect on altered joint tissues, the muscular system, and peripheral blood flow. A serious problem in increasing the effectiveness of the use of therapeutic mud is the knowledge of the mechanism of action of mud procedures. The recognized thermal, mechanical, and biological factors. Local peloid therapy is often considered as a thermal procedure. In recent years, the physicochemical property of mud has been given decisive importance in its therapeutic and biological effects. Recommended mud temperatures have been revised. So, peloid therapy of low temperatures up to 20-24 degrees is recommended for patients with synovitis, with concomitant diseases of the cardiovascular system (varicose veins of the legs, lymphovenous insufficiency, coronary heart disease, arterial hypertension, etc.) Local galvanopeloid therapy is a rather effective method of treatment of OA. However, the multiplicity of joint damage in cases of polyosteoarthrosis is combined with a change in blood circulation in the corresponding segment of the spinal cord and necessitates the use of general exposure procedures in these cases, for example, hydrogen sulfide balneotherapy in combination with segmental exposure procedures - segmental therapeutic massage, segmental techniques of apparatus physiotherapy.

The objective of the invention is to increase efficiency and reduce treatment time, the exclusion of balneopathological reaction.

The task is achieved in that after an adaptation period on days free of hydrogen sulfide baths, galvanopeloid therapy is carried out on the reflex-segmental region of the spine: with primary lesions of the joints of the upper extremities - on the paravertebral zones in the region of C5-D2, and lower limbs - L1-S3, and on an area of no more than two most affected joints per course of 8 balneotherapy and 8 physiotherapy.

The method is as follows: silt mud "Goldpeloid" is heated in a water bath to a temperature of 36-38 degrees. The required amount of dirt (200-250 ml) is placed on a cloth and formed with an envelope-laying with a thickness of 1-2 cm. The impact is carried out on the reflex-segmental region of the spine: with a primary lesion of the joints of the upper extremities on the paravertebral zones in the region of C5-D2, lower extremities - L1-S3 and to the area of no more than two of the most affected joints. Two envelopes (15 × 20 cm) are placed paravertebrally in the corresponding segmental zone of the spine. Electrodes are placed on top of the gaskets ("+" and "_", galvanopeloid therapy is released from both electrodes) from the Potok-1 galvanization apparatus, coated with oilcloth and fixed. The current density of 0.05-0.1 mA / cm ^{2 the} duration is 15 minutes (the polarity of the electrodes alternate through the procedure). Then the envelopes with dirt are placed on the area of one or two of the most affected joints, the electrodes are fixed in a similar manner. The current density is 0.05-0.1 mA / cm2, the duration is 15 minutes. At the end of the procedure, the place of exposure is dried with a napkin. The course is 8 treatments every other day.

Table 1.
Scheme vacation procedures for the proposed method days of treatment Procedures one. climatotherapy, exercise therapy, massage 2. climatotherapy, exercise therapy, massage 3. climatotherapy, exercise therapy, massage, galvanopeloid therapy four. climatotherapy, exercise therapy, massage, WWS 50 mg / l, 36 deg., 6 min 5. climatotherapy, exercise therapy, massage, galvanopeloid therapy 6. climatotherapy, exercise therapy, massage, WWS 50 mg / l, 36 degrees, 8 min 7. climatotherapy, exercise therapy, massage, galvanopeloid therapy 8. climatotherapy, exercise therapy, massage, WWS 100 mg / l, 36 deg., 10 min 9. climatotherapy, exercise therapy, massage, galvanopeloid therapy 10. climatotherapy, exercise therapy, massage, WWS 100 mg / l, 36 deg., 12 min eleven. climatotherapy, exercise therapy, massage, galvanopeloid therapy 12. climatotherapy, exercise therapy, massage, WWS 150 mg / l, 36 deg., 15 min 13. climatotherapy, exercise therapy, massage, galvanopeloid therapy fourteen. climatotherapy, exercise therapy, massage, WWS 150 mg / l, 36 deg., 15 min fifteen. climatotherapy, exercise therapy, massage, galvanopeloid therapy 16. climatotherapy, exercise therapy, massage, WWS 150 mg / l, 36 deg., 15 min 17. climatotherapy, exercise therapy, massage, galvanopeloid therapy eighteen. climate procedures, exercise therapy. massage, WWS 150 mg / l, 36 degrees, 15 min - final examination Note: WWS - common hydrogen sulfide baths.

An example of a specific implementation of the method.

Patient I., 40 years old, suffers from polyosteoarthrosis for 3 years with a primary lesion of the knee, hip joints, small joints of the hands, Ro-2 tbsp., Federal Tax Service 1-2, with concomitant osteochondrosis of the lumbar spine with severe pain, obesity 1 tbsp . An increase in the severity of arthrosis of large joints of the lower extremities - after a closed fracture of the external condyle of the left tibia with displacement of fragments (operated on).

During the last year, she was hospitalized twice in connection with exacerbations of the articular syndrome, synovitis of the left knee joint. Exacerbations are associated with physical overload, hypothermia. The rest of the time it is treated on an outpatient basis, receives a course of chondroprotectors with a good therapeutic effect twice a year. Pain is relieved by taking non-steroidal anti-inflammatory drugs.

The patient underwent treatment according to the proposed method / Table 1 /. (galvanic mud therapy on the lumbosacral region and the region of the hip joints against the background of a course of 8 common hydrogen sulfide baths carried out every other day). Tolerability of the procedures was good. After taking 3-4 procedures of galvanelpeloid therapy, the patient began to significantly decrease pain, stiffness in the joints and spine. By the end of treatment, the patient did not notice pain in the lumbar spine, arthralgia completely stopped. The patient became more active, the range of movements in the joints and spine increased.

Clinical improvement was accompanied by positive changes in laboratory parameters: the clinical blood test remained within normal limits. According to the picture of white blood, a full-fledged “calm activation” reaction was observed. The protective effect on the metabolic processes of connective tissue was confirmed by biochemical studies: the catalase activity of blood plasma significantly decreased from 32.7 μkat / L to 27.4 μkat / L, which was accompanied by a decrease in the number of medium-molecular peptides from 0.292 conventional units. up to 0.240 conventional units; acid mucopolysaccharides with 0.321 units. to 0.232 units, the level of ceruloplasmin decreased from 0.368 g / l to 0.317 g / l, which indirectly indicates a decrease in proteolysis processes under the influence of galvanopeloid therapy. The anti-inflammatory effect of the complex was confirmed by a change in the PSA indicator from 1 to negative. The immunomodulatory effect of the studied therapeutic method was confirmed in the humoral immunity system by a significant decrease in the absolute number of B-lymphocytes from 632.4 to 556.8. The results of rheovasography of the vessels of the lower extremities (lower legs) indicated an improvement in peripheral blood circulation and indirectly confirm the trophic effect of the proposed treatment method: the rheographic coefficient was normalized from 17% to 13% (normal - 10-15%); the average rate of vascular filling increased significantly from 0.11 to 0.41 Ohm / s, although it did not reach normal values (0.9-1.2 Ohm / s). This happened both due to an increase in the average speed of fast filling (from 0.17 to 0.610 m / s), and due to an increase in the average speed of slow filling (from 0.09 to 0.35 Ohm / s); the diastolic index normalized from 0.5 to 0.56 (normal: 0.5-0.75); venous outflow normalized from 73% and 63% on the right and left legs to 20% and 9%, respectively (normal - up to 20%). The results of the survey (SAN questionnaire) revealed an increase in the total activity indicators from 13 to 18 points, moods from 7 to 10 points, a decrease in the level of anxiety from 11 to 13 points. The McGill questionnaire objectively demonstrated a decrease in the intensity and emotional staining of arthralgia: the total number of descriptors decreased from b to 5, the total number of ranks from 14 to 10. The visual-analog scale confirmed the transition of pain from “strong” (5 points) to “moderate” "(3 points).

At the end of the course of treatment, the patient was discharged with significant improvement.

A total of 94 patients were treated in 3 groups with multiple joint damage (polyosteoarthrosis), stages 1-2 according to N.S.Kosinskaya, impaired function of joints of the 0-1 degree at the age of 37 to 62 years, the duration of the disease in the groups averaged 8.2 years In all groups, treatment proceeded against the background of a gentle-training regimen of physical activity, morning and medical gymnastics, climatic procedures, hydrogen sulfide balneotherapy 50-100-150 mg / l, 36 degrees, 6-8-10-12-15 minutes, up to 8 baths per course. Patients were divided into groups identical in sex, age, and severity:

Group 1 - a prototype - 25 patients received a course of 8 common hydrogen sulfide baths every other day and on bath days, galvanopeloid therapy for the two most affected joints.

Group 2 - control - 34 patients on the background of a course of 8 common hydrogen sulfide baths received galvanization to the reflex-segmental region of the spine: with primary lesions of the joints of the upper limbs on the paravertebral zone in the region of C5-D2, and in the lower limbs - L1-S3, and in the region no more than two of the most affected joints, per course of 8 balneotherapy and 8 physiotherapy.

3rd group - the proposed method - 35 patients on days free from common hydrogen sulfide baths received galvanopeloid therapy for the reflex-segmental region of the spine: with primary lesions of the joints of the upper extremities on the paravertebral zones in the region of C5-D2, and the lower extremities - L1-S3, and in the area of no more than two most affected joints, in the course of 8 balneotherapy and 8 physiotherapy.

The effectiveness of complex therapy was evaluated by the dynamics of clinical data, the degree of arthralgia and its structure - by the results of the questionnaire (McGill questionnaire as modified by V.V. Kuzmenko, 1986) and by a digital rating scale in combination with a visual analogue scale (YOUR), questionnaire " self-esteem condition. " The state of peripheral circulation was determined by the results of rheovasography of the limbs. The results of a wedge-orthostatic test and the calculation of the Kerde index indicated the dynamics of the state of the autonomic nervous system. Biochemical studies included the determination of the level of fibrinogen by E. Gachev and acid mucopolysaccharides, which determined the activity of the inflammatory process in the joints. The state of connective tissue metabolism was judged by the content of medium molecules and the number of sulfhydryl groups. The latter with the level of blood catalase also characterized the activity of their own antioxidant system in the human body. Immune status was assessed by a conventional patient immunogram. The state of the protective and adaptive forces of the body was reflected in the detailed formula of white blood and its assessment according to L.Kh. Garkavi-Kvakina.

A comprehensive assessment of therapeutic efficacy indicates the advantage of the proposed treatment complex (Table 2): improvement in the condition of patients was noted in 100% of cases against 94% in the prototype and control groups. Moreover, due to "significant improvement": 54.3% versus 16% in the prototype and 29.4% in the control group. At the same time, the stress of the treatment complex was not noted, which is confirmed by the absence in the studied groups of differences in the number of balneopathological reactions.

At the end of the course of complex therapy, patients noted a feeling of a surge of vigor and strength, relief of pain with an increase in range of motion. The analgesic effect of the studied treatment complexes is objectively reflected in table 3. The results of the questionnaire indicate a more pronounced analgesic effect of the proposed method of treatment: the sum of the ranks of pain significantly decreased - 10.5 versus - 7.6 in the prototype and - 9.2 in the control group. Moreover, an analysis of the structure of the pain syndrome indicates a decrease in the predominantly sensory qualities of pain.

The severity of anti-inflammatory action compares favorably with the proposed treatment complex. It is confirmed not only by the described analgesic effect, but also by the reliable dynamics of a number of biochemical parameters. So, with a general positive orientation in all studied groups of patients with normalization of fibrinogen level from 3.48 + 0.10 g / l to 2.60 + 0.20 g / l, a significant decrease in the total amount of acid mucopolysaccharides from 0.275 + 0.01 up to 0.250 + 0.01 g / l (P <0.05) and CRP was detected only in the proposed treatment complex. These therapeutic effects naturally affected the clinical picture of the disease. In patients with polyosteoarthritis against the background of galvanic mud therapy, periarticular changes in the joints significantly decreased and, as a result, the volume of performed movements in them increased, more pronounced in the group of the proposed method (Table 4). It should be noted that at the same time the feeling of stiffness in the spine decreased, the range of movements in it increased. At the same time, patients noted the disappearance of chilliness and numbness of the limbs. The indicated therapeutic effect is due to the combined effect of both galvanic current and the application of the peloid on the reflex paravertebral zones with trophic effects on the peripheral nervous system and, as a consequence, peripheral hemodynamics. Confirmation of this is significant shifts in a number of biochemical parameters and rheovasography of limb vessels. So, in the group with the proposed method of treatment, there is a significant decrease in the number of medium molecules from 0.274 + 0.01 units. up to 0.249 + 0.01 units In the control group of patients, stimulation of AOS was noted, which was manifested by a significant increase in the level of blood catalase from 28.8 + 1.6 microns cat / l to 33.9 + 1.3 microns cat / l (P <0.05) and was naturally combined with conservation high values of lipid peroxidation products. At the same time, the advantage of the proposed method is not only a positive trophic effect, but also the containment of destructive processes in the connective tissue. This fact is confirmed by a detectable tendency to a decrease in the values of diene conjugates from 3.05 + 0.2 units. up to 2.8 + 0.2 units, which, in contrast to the control group, results in the absence of dynamics of AOS indicators.

The normalization of the state of the autonomic nervous system in the studied groups by the end of the course of therapy was manifested in the dynamics of indicators of a wedge-orthostatic test (CPC): the normotonic version of CPC was detected in 73.5% and 74.3% of cases, respectively, in the control and in the prototype; with the proposed method of treatment, the number of cases with a normal Kerde index increased 2 times.

Complex spa therapy favorably affected the state of the compensatory-adaptive forces of the body. In the control group of patients, the number of cases of “calm activation” significantly increased from 50.0% to 76.0% due to cases of “training” and “increased activation”. In the group of patients treated by the proposed method, expressed changes in the adaptation system were not observed. Moreover, the advantage of the most favorable reaction of "increased activation" to 66.0% was preserved, which indicates the absence of the stress effect of the studied medical complex. The results of the analysis of the “state self-assessment” questionnaire indicate the advantage of the proposed method of treatment using galvanopeloid therapy for the reflex-segmental region of the spine: by the end of the course of treatment, the patients' activity “increased significantly by 5.7 points versus +3.8 points in the control and the mood indicator "by 7.2 points versus +5.5 points in the control group.

The dynamics of indicators of the immune status was unreliable. By the end of the course of treatment, lymphocytosis persisted, mainly due to T-lymphocytes. At the same time, the number of B-lymphocytes tended to decrease without pronounced dynamics of the level of immunoglobulins. The absence of autoimmune aggression, despite the multiplicity of articular syndrome, is confirmed by the normal values of the T-suppressor population of T-lymphocytes.

Thus, in cases of polyosteoarthrosis, regardless of the stage of the disease during the period of complete or incomplete remission, combined with osteochondrosis of the spine, the appointment of a comprehensive spa treatment with a course of common hydrogen sulfide baths in combination with a segmental-local galvanic mud therapy provides pronounced anti-inflammatory, analgesic effects, positive local and segmental trophic effects with phenomena of improving the condition of the peripheral and autonomic nervous systems, peripheral Who circulation, which manifests an increase in therapeutic efficacy resort rehabilitation of patients by an average of 10-15% in the shorter term to 18 days, while the absence of a pull-medical complex.

The source of information

1. Kurtaev O.Sh., Ibadova GD, Zavora M.I., Lopatinsky V.V., Makarova N.A. Experience in the use of silt sulfide mud in the Sochi region in the spa rehabilitation of patients with osteoarthrosis. The collection of scientific works "Rehabilitation" - the first issue. - M., 2003.

Claims (1)

A method for the treatment of osteoarthrosis by conducting common hydrogen sulfide baths with a concentration of hydrogen sulfide of 50-150 mg / l every other day and the effect of galvanopeloid therapy on the affected joints on bath days, characterized in that after adaptation on bath days, galvanopeloid therapy is carried out on reflex segmental region of the spine: with a primary lesion of the joints of the upper extremities - to the paravertebral zones in the region of C5-D2, and the lower extremities - in the region of L1-S3, and then to the region of one or two naib more affected joints, in the course of 8 balneotherapy and 8 physiotherapy.