RU2290215C1 - Method for treating the cases of neurological manifestations of vertebral column osteochondrosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves treating the most painful areas in lumbar zone with sinusoid modulated alternating current. The treatment is given in two cycles each composed of two working periods with 4 pulse batches available in each period. I kind of works is applied in addition. One batch has two kinds o works. Currents are applied in proportions of 3-3 s in III and IV kind of works. The kinds of works are changed every 9 s in a batch as follows. The first working period and the first batch: alternating current mode, III kind of works and then I kind of works; rectified current mode, I kind of works, alternating current mode, I kind of works, and then III kind of works. The second batch: rectified current mode, I kind of works, alternating current mode, I kind of works, and then III kind of works; rectified current mode, I kind of works, alternating current mode, III kind of works, and then I kind of works. These two batches are repeated. The second working period and the first batch: alternating current mode, IV kind of works, then III kind of works, rectified current mode, III kind of works, alternating current mode, III kind of works and then IV kind of works. The second batch: alternating current mode, III kind of works and then IV kind of works, rectified current mode, III kind of works, and then III kind of works; rectified current mode, III kind of works, alternating current mode, IV kind of works, and then III kind of works. These two batches are repeated once more, the first and the second working periods are repeated once more.

EFFECT: accelerated treatment course; reduced risk of vegetative vascular disorders.

2 dwg, 1 tbl

Description

The invention relates to medicine, namely to physiotherapy, and can be used to improve the quality of treatment of neurological manifestations of spinal osteochondrosis.

In modern vertebral neurology, methods are widely used for treating neurological manifestations of spinal osteochondrosis using a variety of physiotherapy methods (Gurlenya A.M. Physiotherapy and balneology of nervous diseases. / A.M. Gurlenya, G.E.Bagel. - Minsk: Higher School, 166) . As a rule, when stopping acute somatogenic and neurogenic pain syndromes, low-frequency pulsed currents (sinusoidal modulated, diadynamic, fluctuating, interference, etc.) are used (Bogolyubov V.M. General Physiotherapy: Textbook / V.M. Bogolyubov, G. N. Ponomarenko. - 3rd ed., Revised and additional - Moscow: Medicine, 1999. p.102).

Recently, many authors see ways to further improve the methods of physiotherapeutic effects in their biorhythmological optimization (Komarov F.I. Chronobiological direction in medicine: biocontrolled chronophysiotherapy / F.I.Komarov, S.L. Zaguskin, S.I. Rapoport // Therapeutic Archive - No. 8. - 1994. - S.3-6).

Biological rhythms (BR) are found at all levels of the organization of wildlife - from unicellular to the biosphere. They are recognized as the most important mechanism for homeostasis of the body. On the one hand, BRs have endogenous nature and genetic regulation, on the other hand, their existence is closely related to the variability of environmental factors (Chronobiology and Chronomedicine / Edited by F.I. Komarov and S.I. Rapoport; 2nd ed. - M: Triad-X. - 2000, p. 318.). All BRs are divided into internal (physiological) and external (environmental). According to S.L. Zaguskin, the standard of biological time for a multicellular organism is the pulse rhythm, and for the biocenosis - the circadian rhythm.

Physiological rhythms, as a rule, are genetically determined and have periods from fractions of a second to several minutes. In the evolutionary aspect, their origin is associated with micropulsations of the geomagnetic field, ionosphere, electromagnetic noise, fluctuations in the brightness of the Sun, etc. So, the rhythms of tremor, α-waves of EEG, ECG correlate with electromagnetic waves and are multiples of a frequency of 8 hertz (Balneology and physiotherapy: a guide in 2 volumes / Edited by V.M. Bogolyubov. - M .: Medicine, 1985. - T.1. - p.62).

K.B. Petrov and O.S. Kalinina (K.B. Petrov, O.S. Kalinina Features of the biorhythmological activity of the spinal cord: A medical strategy in the new century. / Materials of the Kuzbass Scientific and Practical Conference dedicated to the 75th anniversary of the MLPU Gorodskaya Clinical Hospital No. 2 "- Novosibirsk 2004. - p.207) 3 components of biorhythmic activity of the spinal cord are normal: the ultra-low-frequency component (0.02 Hz), the low-frequency component (0.1 Hz) and the high-frequency component (0.3 Hz) .

There is a method of individual biosynchronization of low-frequency pulsed currents in the treatment of pain of spinal osteochondrosis (Bely K.P. Method for the treatment of pain. Patent of the Russian Federation No. 2234951 according to CL 7 A 61 N 1/32, published in BIPM No. 24 from 08/27/2004, p .397), which consists in exposure to low-frequency modulated currents until the patient has a feeling of vibration and tissue contraction under the electrodes, while the current strength is increased to local pain. After the cessation of sensation, the current strength is again increased until the initial soreness appears, and so they are brought to a complete cessation of the appearance of any pain, limiting the duration of the procedure to 30 minutes.

The disadvantage of this method is:

1) lack of neurophysiological substantiation of the method;

2) the use of one operating mode throughout the procedure, which contributes to the rapid adaptation to this method of physiotherapy;

3) an excessively long duration of the procedure (30 minutes);

4) a sequential increase in amperage during the holiday procedure may exceed the threshold of pain sensitivity, this will lead to a psychoemotional reaction or vegetative-vascular disorders.

The closest is the usual method of treatment with sinusoidal modulated currents used according to the standard scheme: variable mode, type of operation (PP) - III, modulating current frequency (FM) - 100 Hz, modulation depth (GM) - 75%, duration of the packages - 2- 3 seconds, 3-5 minutes; parcel duration - 3 sec., 3-5 min. (Bogolyubov V.M. General physiotherapy: Textbook. / V.M. Bogolyubov, G.N. Ponomarenko. - 3rd ed., Revised. And add. - Moscow: Medicine, 1999. - p. 100).

The disadvantages of the method:

There is no accounting for the biorhythmological activity of the body, which reduces the effectiveness of the effect and increases the treatment time.

The objective of the present invention is to improve the quality of treatment of patients with neurological manifestations of osteochondrosis with sinusoidal modulated currents by biorhythmological optimization of exposure by changing the rhythm of the electric current and its duration with the biological rhythm of the spinal cord.

The task is achieved in that in the treatment of neurological manifestations of spinal osteochondrosis, the most painful areas in the lumbar region are affected by sinusoidal modulated alternating currents with a change in type of work III to IV with a change in frequency-amplitude modulation and exposure time. Treatment is carried out in two cycles, each of which consists of two working periods. In each period, 4 bursts of pulses. Additionally, I type of work is used. Moreover, one pack consists of two kinds of work. In the III and IV kind of work, the duration of sending frequency-amplitude modulation of the current is 3-3 sec. The type of work in the pack is changed every 9 seconds. The first working period is the first pack: alternating current mode III type of work and then I type of work; rectified current mode I kind of work, alternating current mode I kind of work and then III kind of work, second pack: alternating current mode I kind of work and then III kind of work; rectified current mode I type of work, alternating current mode III type of work and then I type of work. These two packs are repeated. The second working period, the first pack: alternating current mode IV type of work, then III kind of work, rectified current mode III kind of work, alternating current mode III kind of work and then IV kind of work, the second pack: alternating current mode III kind of work and then IV kind work, rectified current mode III kind of work, alternating current mode IV kind of work and then III kind of work. These two packs are repeated again. The first and second working periods are repeated again.

The novelty of the invention:

- Treatment is carried out in two cycles, each of which consists of two working periods. In each period, 4 bursts of pulses. Additionally, I type of work is used. Moreover, one pack consists of two kinds of work. In the III and IV kind of work, the duration of sending frequency-amplitude modulation of the current is 3-3 sec. The type of work in the pack is changed every 9 seconds.

- The first working period, the first pack: alternating current mode III type of work and then I type of work; rectified current mode I kind of work, alternating current mode I kind of work and then III kind of work, second pack: alternating current mode I kind of work and then III kind of work; rectified current mode I type of work, alternating current mode III type of work and then I type of work. These two packs are repeated.

- The second working period, the first pack: alternating current mode IV kind of work, then III kind of work, rectified current mode III kind of work, alternating current mode III kind of work and then IV kind of work, the second pack: alternating current mode III kind of work and then IV type of work, rectified current mode III type of work, alternating current mode IV type of work and then III type of work. These two packs are repeated again.

- The first and second working periods are repeated again.

Achieved result:

Improving the quality and effectiveness of treatment by normalizing muscle tone, reducing the number of procedures, reducing pain in a shorter time.

The theoretical justification of the proposed method was a preliminary study of a group of healthy volunteers of 55 people (41 men and 14 women) aged 18 to 65 years, by studying the per-second dynamics of the H-reflex (ratio (N / M) · 100%) in the calf muscle within 6 minutes (360 seconds) according to the standard method (Badalyan L.O. Clinical Electroneuromyography: A Guide for Doctors / L.O. Badalyan, I.A. Skvortsov. - M .: Medicine, 1986.- p. 218. Baykushev St. Stimulating electromyography and electroneurography in the clinic of nervous diseases / St. Baikushev, Z.K. Manovich., V.P. Novikova. - M .: Medicine, 1974. - p. 81).

It is known that the H-reflex is a sensitive indicator of both downward influences and the intrinsic activity of the segmental apparatus of the spinal cord (Kots, Y.M. Organization of voluntary movement / Ya.M. Kots. - M .: Nauka, 1975. - p.105 )

Statistical processing was performed using the following programs: Microsoft @ "Excel 2002", "Caterpillar-1.0", "STATGRAPHICS Plus-3.0" and "SPSS-9.0 for Windows" (table 1).

Table 1
General characteristics of the frequency components of the biorhythmic activity of the spinal cord Gender (people) Number of measurements Period (sec) Frequency Hz)* Specific The weight (%) Microwave component We are testing everything. 55 295 44.67 ± 2.005 0.022 ± 0.001 60.19 ± 3.77 Men 41 225 47,578 + 2.27 0.021 + 0.001 59.817 + 4.19 Women fourteen 81 42.65 ± 4.802 0.023 ± 0.006 61.18 ± 8.927 Low frequency component We are testing everything. 55 1857 9.17 + 0.16 0.109 + 0.002 11.35 + 1.87 Men 41 1428 9,251 + 0,184 0.108 + 0.0025 11,865 + 2,377 Women fourteen 459 9.044 ± 0.292 0.111 + 0.003 9.384 ± 2.235 High frequency component We are testing everything. 55 3488 3.19 + 0.0378 0.313 + 0.004 26.271 + 2.89 Men 41 2616 3.219 ± 0.044 0.311 ± 0.004 26.896 ± 3.52 Women fourteen 795 3.123 ± 0.008 0.32 ± 0.008 24.65 ± 4.957 ^* Frequency calculated as ¹ / _period

The most numerous is the ultralow-frequency component (ELF) with an acrophase period of 44.7 sec (0.02 Hz). Its specific gravity averages 60.2% of the total data set for each subject (Table 1). The second highest percentage (26.2%) was the high-frequency component (HF) with a period of 3.2 seconds (0.3 Hz). The smallest contribution (11.4%) to the biorhythmic ensemble of the spinal cord is made by the low-frequency component (LF)), its period corresponds to 9.2 sec (0.1 Hz).

Thus, new data were obtained on the presence of at least three components of the biorhythmic activity of the spinal cord normal with periods of 45.9 and 3 seconds, that is, their multiplicity corresponds to 3. This information can be used to optimize the methods of amplipulse therapy in the treatment of patients with neurological manifestations of osteochondrosis of the spine (NPOP).

The invention is illustrated by drawings, which reflect the change in current mode and operating periods of exposure by the apparatus "Amplipulse-4".

Figure 1 shows the first working period.

Figure 2 shows the second working period.

The individual components of the working period correspond to certain frequency ranges:

- one burst of pulses lasting 45 seconds is equal to the ultra-low frequency range (VLF);

- the duration of the impact of one kind of work is 9 seconds, this corresponds to the period of the low-frequency range (LF);

- the duration of sending frequency-amplitude modulation of the current when exposed to the III and IV types of work is 3-3 seconds, which corresponds to the period of the high-frequency range (HF).

The nine-second and forty-five-second intervals are counted using a stopwatch, and a three-second interval is stored in the device.

Our proposed technique is implemented on the Amplipuls-4 apparatus or on similar devices of later modifications after a small refinement of their electronic circuit.

In the standard version of these devices, developers have provided hard-coded options for sending the frequency-amplitude modulation equal to 1-1.5; 2-3; 3-6 seconds, which does not coincide with the selected biorhythms. Therefore, the device was redone in such a way that the ratio of the duration of sending frequency-amplitude modulation began to correspond to 3-3 seconds.

The procedure consists of 2 working periods, each period lasting 3 minutes. The periods contain 4 bursts of pulses, the duration of one burst is 45 seconds. Each pack has 5 intervals of 9 seconds due to the alternation of different kinds and modes of operation. In the third and fourth kind of work, each of these intervals is divided into 3 three-second periods, which differ in the frequency of current modulation. The first 9 seconds the impact is III RR in alternating mode, FM - 100 Hz, GM - 75-100%, the duration of sending frequency-amplitude modulation of the current - 3-3 seconds. Then, keeping the previous settings, I PP is turned on for 9 seconds. In the next nine-second interval, without changing the type of work, the rectified mode is set, after which the variable mode I PP returns for 9 seconds. In the final 9 seconds, III PP is repeated.

The next three packs differ from each other only by changing the sequence of alternation of I and III PP.

The second working period begins with IV PP (the alternation of the duration of the packages is the same) - 9 seconds (the frequency and modulation depth parameters, the ratio of the packages and pauses remain the same), then III PP is repeated - 9 seconds, after which the rectified mode is turned on for 9 seconds, and then again followed by nine-second intervals of variable modes W and IV PP. In the next three packs of III and IV, the PPs change places each time.

Treatment algorithm

For all packs, the parameters do not change: FM-100 Hz; GM-75%; the duration of sending the frequency-amplitude modulation of the current is 3-3 seconds and sequentially turn on:

First working period:

One working period consists of 4 packs of pulses, the first and second pack of pulses correspond to the third and fourth packs.

Then leaving the FM, GM, the duration of sending the frequency-amplitude modulation of the current the same, but sequentially turn on:

Second working period:

The second working period consists of 4 packs of pulses, the first and second pack of pulses correspond to the third and fourth packs.

Repeat the first and second working periods again.

Example 1. Patient K., 32, appealed April 6, 2004 with complaints of pain in the lumbar region, more to the right, radiating along the outer surface of the right thigh to the knee and wearing a breaking-aching-bursting character. In addition, moderate pain was observed in the cervical-collar zone, the right shoulder girdle and the outer surface of the right shoulder.

The exacerbation began 3 days ago after weight lifting. Initially, the patient felt acute pain in the lower back, but after a few hours it spread to the thigh area, and the next morning the pains in the region of the shoulder girdle joined.

Suffers from lumbar osteochondrosis for 3-4 years, exacerbations up to 1-2 times a year.

A palpation study found an increase in tone and soreness of the muscles of the lower back

The X-ray examination in the supine position confirmed the presence of right-sided lumbar scoliosis and straightening of lumbar lordosis, established signs of spinal osteochondrosis in the form of intradiscal dystrophy at the level of L ₅ -S ₁ segment.

Diagnosis. Lumbar osteochondrosis (intradiscal dystrophy leading to a disc fissure L ₅ -S ₁ ). Right-sided lumbar ischialgia syndrome on the right. III degree of severity of clinical manifestations.

The position of the patient lying on his stomach. Electrodes 5 × 15 cm in size are placed paravertebrally in the lumbosacral region, corresponding to the greatest palpation tenderness and fixed with a load.

1. After turning on the device in the network, set the maximum output current range to “80 mA”. Using the appropriate control panel switches, we set the following initial parameters: III type of work (PP), variable mode, modulation frequency - 100 Hz; modulation depth - 75%; the duration of sending frequency-amplitude modulation of the current is 3-3 seconds. Then we smoothly withdraw the current by rotating the regulator until the patient has a feeling of vibration under the electrodes. Turn on the manual stopwatch.

2. After 9 seconds, keeping the previous settings, we switch the button "type of work" to I PP. After another 9 seconds, we change the operating mode from variable to rectified, the rest of the settings remain the same. After the next nine second interval, we again turn on the alternating mode for another 9 seconds. In the next 9 seconds, turn on III PP. This is the first pack. We go again to the I PP (9 sec), then to the III PP (9 sec). After another 9 seconds, we change the operating mode from variable to rectified, the rest of the settings remain the same. After the next nine second interval, we turn on the III PP, and then I PP. This is the second pack. Repeat these two packs again, 3 and 4 packs.

3. Without changing the remaining parameters, turn on the IV PP and measure out 9 seconds, after which we switch to III PP - 9 seconds. Then for 9 seconds we turn on the rectified mode, and after their expiration we again return to the variable mode. After the next nine second interval, go to the IV RR and again detect 9 seconds. This is the first pack. Turn on the III PP (9 sec), then the IV PP (9 sec), the mode is variable. For 9 seconds we turn on the rectified mode, and after it we again return to the variable mode, sequentially including IV PP, III PP for 9 sec. This is the second pack. Repeat these two packs again, 3 and 4 packs.

4. Once again, we return to paragraph 1, after which we repeat the entire sequence of operations described in paragraphs 1, 2, and 3.

Thus, the total duration of the procedure reaches 12 minutes. For complete relief of the pain syndrome, 5 procedures were required. Usually, with a standard technique, 10 procedures are performed.

Improving the quality and effectiveness of treatment due to the normalization of muscle tone made it possible to reduce the number of procedures and reduce pain in a shorter time, which increased the patient's quality of life.

Claims (1)

A method of treating neurological manifestations of osteochondrosis of the spine, including exposure to the most painful areas in the lower back with sinusoidal modulated alternating currents with a change in the type of work III to IV with a change in frequency-amplitude modulation and exposure time, characterized in that the treatment is carried out in two cycles, each of which consists of two working periods, in each period of 4 bursts of pulses, additionally I type of work is used, moreover, one pack consists of two kinds of work, in III and IV kind work If the current ratio is 3–3 s, the type of work in the pack is changed every 9 s, as follows: first working period first pack: alternating current mode III type of work and then I type of work; rectified current mode I kind of work, alternating current mode I kind of work and then III kind of work, second pack: alternating current mode I kind of work and then III kind of work; rectified current mode I type of work, alternating current mode III type of work and then I type of work, these two packs are repeated; second working period first pack: alternating current mode IV kind of work, then III kind of work, rectified current mode III kind of work, alternating current mode III kind of work and then IV kind of work, second pack: alternating current mode III kind of work and then IV kind work, rectified current mode III kind of work, alternating current mode IV kind of work and then III kind of work, these two packs repeat again, the first and second working periods are repeated again.

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