RU2299733C1 - Method for treating patients for degenerative dystrophy diseases of locomotor apparatus and post-traumatic commissure processes - Google Patents

Abstract

FIELD: medical engineering.

SUBSTANCE: method involves Chondroxide ointment is mixed with Indometacin ointment and Essaven gel in proportion of 1:1:1. 50 mg of a Caripazyme enzyme preparation, dissolved in 5 ml of the physiological salt solution is added. Then, the produced suspension put on injured regions. Ultraphonophoresis is applied daily for 5 min on each region. The total treatment course is 15-20 procedures long.

EFFECT: improved anesthetic action, anti-inflammatory and chondroprotective action; improved microcirculation in injured region; accelerated rehabilitation period.

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Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the complex treatment of post-traumatic dystrophic, degenerative and scar adhesions in the field of joints, deforming osteoarthritis of large joints and osteochondrosis. Widely known are methods of local therapy of lesions of the musculoskeletal system with ointment forms of non-steroidal anti-inflammatory drugs, such as diclofenac, ibuprofen, ketoprofen, indomethacin [Alekseeva L.I. // Russian medical journal. - 2000. - T.8 - No. 9. - S. - 377-386; Chichasava N.V. // Russian medical journal. - 2001. - T.9 - No. 7-8. - S. - 286-288]. The main indications for their use are synovitis, inflammatory diseases of the periarticular tissues, post-traumatic pain syndromes, back pain. Ointments are applied to the skin in the affected area many times during the day in order to provide an adequate analgesic and anti-inflammatory effect. Clinical studies have shown [Chichasava N.V. // Russian medical journal. - 2001. - T.9 - No. 7-8. - S.286-288], that the minimum is 3-4-fold application of the drug per day, and with active inflammation, the frequency of application can increase up to 5-6 times a day. The disadvantage of this method is the need for repeated application of the drug to the skin during the day to maintain the optimal concentration of the active drug in the tissues. Elderly people need to increase the amount of the drug applied or increase the frequency of its use due to reduced (due to physiological characteristics) skin permeability [Chichasava N.V. // Russian medical journal. - 2001. - T.9 - No. 7-8. - S.286-288]. The introduction of these drugs by phonophoresis provides a more reliable penetration of the drug to the site of inflammation [Chichasava N.V. // Russian medical journal. - 2001. - T.9 - No. 7-8. - S.286-288; Ulashchik V.S. New methods and techniques of physical therapy // Ulashchik V.S. - Minsk. Belarus. 1986. - S. 175].

A known method of treating arthrosis of large joints by phonophoretic introduction to the lesion area of hydrocortisone. [Reshetov P.P., Tverdokhleb Yu.P., Bezmenov V.A. // Issues of balneology, physiotherapy and physiotherapy - 2000. - No. 4. - S. - 47-48]. Indications for such treatment are arthrosis of large joints 1-11 tbsp. with synovitis. In general, during treatment with the proposed method, improvement, manifested by a decrease in pain, is noted by 70% of patients [Reshetov P.P., Tverdokhleb Yu.P., Bezmenov V.A. // Issues of balneology, physiotherapy and physiotherapy - 2000. - No. 4. - S. - 47-48]. The disadvantages of this method are the possibility of purulent-inflammatory complications in the skin at the site of application of the drug (due to the reduction of local skin protection factors by glucocorticosteroids), the low efficiency of the method under monotherapy.

In the literature there is evidence of the possibility of using Capsicam ointment in the complex treatment of degenerative-dystrophic diseases of the musculoskeletal system. The ointment contains dimethyl sulfoxide, a combination of two active vasodilating components for topical application of vanillylnonamide and benzyl nicotinate, as well as turpentine and camphor, which have an irritating and analgesic effect. In this case, the ointment must be applied at least 2-3 times a day [Kuryata A.V., Kudel IV, Belozerova EV, Kharkovskaya SV // Medical business - 2004. - No. 3-4. - S. - 97-100] to ensure a sufficient clinical effect, manifested in a decrease in pain and a decrease in inflammatory phenomena. The disadvantages of this method is the need for repeated application of the drug during the day to ensure adequate clinical effect declared by the manufacturer, as well as low clinical effect with monotherapy.

There is a method of treating neurological and traumatologic orthopedic diseases associated with the development of degenerative and scar adhesions by electrophoretic administration of a proteolytic enzyme preparation of caripazim obtained from the melon tree latex Carica papaya [Pat. 2141359 RF, MKI A61N 1/30, A61K 35/78 A method for the treatment of neurological and orthopedic traumatological pathologies]. This method is used, for example, in the treatment of cervical and lumbar osteochondrosis, discogenic radiculitis, facial neuritis, keloid and hypertrophic scars. In this case, filter paper is moistened with a solution of the caripazim drug with the addition of dimethyl sulfoxide (DMSO), applied to the skin in the area of pathology, an electrically conductive pad and a positive electrode are placed on top, and additional administration of aminophylline or potassium iodide is possible from the negative electrode. The disadvantages of this method of treatment are:

- with conventional electrophoresis techniques, part of the drug applied to the filter paper, after the procedure remains on it and is irretrievably lost;

- by electrophoresis it is impossible to introduce multicomponent drugs, especially those containing ointment forms that are necessary for the complex treatment of degenerative diseases.

According to modern standards of treatment of osteoarthritis [Alekseeva L.I. // Russian medical journal. - 2000. - T.8 - No. 9. - S. - 377-386; Borovikov, N.N. Modern approaches to the complex therapy of osteoarthritis using Chondroxide ointment // Borovikov N.N. - Nizhny Novgorod. NIZHFARM. 2002. - S. - 28; Chichasova N.V. // Russian medical journal. - 2003. - T.11 - No. 23. - S. - 1277-1279], the complex therapy of this disease should include drugs with chondroprotective properties, which are the natural components of cartilage - hyaluronic acid, glucosamine and chondroitin sulfate. Chondroprotectors improve cartilage metabolism, slow down or prevent its destruction. There is a method for the treatment and prevention of the progression of degenerative joint diseases through the use of ointment "Chondroxide" 5%, which is one of the most famous and affordable drugs and gives a pronounced therapeutic effect when applied topically. Due to the presence of dimethyl sulfoxide in the ointment, the drug - chondroitin sulfate - penetrates deep into the tissue. The ointment is applied 2-3 times a day to the skin over the lesion and rubbed until completely absorbed for 2-3 minutes. The course of treatment is 2-3 weeks. The disadvantage of this method are:

- its low efficiency in monotherapy,

- the need for repeated use of the drug during the day,

- lack of anti-inflammatory effect,

- lack of decongestant effect,

- the absence of the effect of improving microcirculation in the affected area.

We first developed a method for the treatment of degenerative-dystrophic diseases of the musculoskeletal system, which allows a comprehensive effect on the pathological process during one treatment procedure. The proposed method involves applying to the lesion area ointments “Indomethacin”, “Chondroxide”, “Essaven” gel and the enzyme preparation Karipazim, the drugs being applied in the form of a suspension of the following composition: ointments “Indomethacin”, “Chondroxide” and “Essaven” gel in proportion 1: 1: 1, mixed with 50 mg of Karipazim, dissolved in 5 ml of saline. The suspension is administered by ultraphonophoresis for 5 minutes on the field, daily, in a course of 15-20 procedures.

The method is as follows. An agitated suspension is prepared, for which they are mixed in a 1: 1: 1 ratio ointment “Chondroxide” 5% and “Indomethacin” 10%, gel “Essaven”. The amount of ointment depends on the size of the joint: for large joints (knee, shoulder) a strip of ointment 5-10 cm long is squeezed out, for medium joints (ulnar, radial, ankle) 3-5 cm (according to the recommendations [N.V. Chichasava // Russian medical Journal. - 2001. - T.9 - No. 7-8. - S. - 286-288]). Then add 50 mg of the powdered preparation Karipazim with an activity of 350 PE dissolved in 5 ml of physiological saline. The talker is applied to the skin in the area of pathology. Then they are affected by low-frequency ultrasound with an intensity of 0.2-0.4 W / cm ² paravertebrally and 0.4-0.6 W / cm ² on the limbs and joints for up to 5 minutes on the field (according to the standard method [V. Ulashchik. New methods and techniques of physical therapy / V.S. Ulashchik. - Minsk: Belarus, 1986. - S. - 175]). Ultraphonophoresis is carried out daily, for a course of 15-20 procedures. If necessary, repeat the treatment.

Chondroprotector - Chondroxide ointment and Indomethacin ointment, which has a local analgesic, anti-inflammatory and anti-edematous effect, Essaven gel, which improves microcirculation and also has analgesic, anti-edema and anti-inflammatory properties, are used in combination with Caripazime for the treatment of various links -dystrophic diseases of the musculoskeletal system and potentiation of the therapeutic effect. The method of introducing these drugs selected low-frequency ultrasound, because this complex satisfies several conditions [Ulashchik V.S. New methods and techniques of physical therapy / V.S. Ulashchik. - Minsk: Belarus, 1986. - S. - 175, Ulashchik V.S. Essays on General Physiotherapy / B.C. Ulaschik. - Minsk: Navuka i tehnika, 1994. - S. - 200]:

- The ointment bases that are part of the ointments Chondroxide, Indomethacin and Essaven gel are a suitable contact medium for ultrasound.

- For ultra-phonophoretic administration, bioactive compounds are used that exhibit their maximum effect even at low dosages, including the enzyme preparation Karipazim and the structural modulator chondroitin sulfate, which is part of the Chondroxide ointment.

- These drugs in their effect on the pathogenetic links of the disease are synergistic with the action of a physical factor, because low-frequency ultrasound provides the occurrence of the phenomenon of tissue micromassage, loosening, improving microcirculation and regional blood circulation, accelerating diffusion and metabolic processes [Ismayilov AA, Kuliev R.A. // Bulletin chir. - 1985. - No. 2. - P.146-148], stimulates regenerative processes [V. Ulashchik. // Issues of balneology, physiotherapy and physiotherapy. - 2000. - No. 6. - P.3-8], has an anti-inflammatory property, promotes the introduction of a larger number and to a greater depth of drugs during their ultraphonophoresis [Ulashchik V.S. // Issues of balneology, physiotherapy and physiotherapy. - 2000. - No. 6. - C.3-8].

Under our supervision, there were 40 patients aged 21 to 68 years with diseases of the musculoskeletal system. The distribution of diagnoses is presented in the table. Depending on the type of treatment, we identified three groups of patients.

Table. Diagnosis Number of patients I group II group III group Gonarthrosis stage I-II 5 four 5 Injuries of capsular ligaments of various joints 5 5 5 Osteocondritis of the spine 3 four four Number of patients 13 13 fourteen

Group I patients received treatment according to our proposed method. They performed the phonophoretic administration of a drug suspension of the following composition: Chondroxide ointment 5%, Indomethacin ointment 10%, Essaven gel in a ratio of 1: 1: 1 with the addition of 50 mg of Karipazim powder with an activity of 350 PE dissolved in 5 ml saline solution. The suspension was applied to the skin in the area of pathology, then it was exposed to low-frequency ultrasound.

The II group of patients was performed with phonophoresis of ointment “Indomethacin” 10%, and ointment “Chondroxide" 5% on the affected area.

Group III patients underwent caripazim electrophoresis according to a known method [V. Ulashchik New methods and techniques of physical therapy / V.S. Ulashchik. - Minsk: Belarus, 1986. - S. - 175] on the pathology zone. All groups of patients received procedures daily; the course of treatment was 15 procedures.

In the course of treatment, we monitored the dynamics of the patients' condition. The following indicators were investigated: joint pain at rest, during movement, local swelling of periarticular tissues, increased joint mobility. Each indicator was evaluated on a 10-point scale, with “0” points corresponding to its minimum severity, “10” points - maximum. The dynamics of the indicators in the treatment process is shown in figures 1, 2, 3, 4. On the graphs presented, the x-axis shows the duration of treatment (number of procedures), the y-axis shows the severity of the indicator in points. Figure 1 shows the dynamics of the severity of pain at rest, figure 2 - with active movements. Figure 3 presents the change in local swelling of periarticular tissues during treatment. Figure 4 shows the process of improving mobility in the affected joints.

In group I of patients treated by our proposed method, there was a significant decrease in the intensity of pain at rest and with active movements after 2 procedures, after 4-5 procedures, its intensity decreased almost by half, and by the end of the course of treatment (after 14-15 procedures ) pain was stopped in 95% of patients. In the II group of patients who underwent phonophoresis of ointments “Indomethacin” and “Chondroxide”, and in the III group who received electrophoresis of the enzyme preparation Karipazim in the area of pathology, the intensity of pain at rest and with active movements decreased after 5-7 procedures, and a more significant improvement was achieved after 9-10 procedures, after the end of treatment the pain was completely stopped in 70% of patients. In the state of periarticular tissues, a more pronounced positive dynamics was observed in group I of patients: local swelling and edema significantly decreased after 5-6 procedures, by the end of treatment they were slightly expressed in most patients. In groups II and III, the manifestations of this symptom began to decrease noticeably after 8–9 procedures, and at the end of treatment, local swelling persisted in a larger number of patients than in group I. Improvement of joint mobility in group I began already after 2 procedures (in II and III groups - after 5-6 procedures), after 6-7 procedures the improvement was more significant, by the end of treatment it was restored almost completely in most patients.

Example 1. Patient K., 58 years old. From the anamnesis it is known that about 5 years ago I began to feel an unpleasant dull pain, a crunch in the knee joints that occurs in the evening and with intense movements. I did not seek medical help. It was treated independently, at home. Over the past 6 months, the pain began to gradually increase, worried already with small movements in the joints, swelling began to appear in the knee joints, constantly worried about a crunch during movements, as a result of which the patient turned to the district clinic, where she was recommended hospitalization in a specialized hospital. As a result, the patient was admitted to the clinic of traumatology and orthopedics with a direct diagnosis of “Deforming osteoarthritis”. Clinical and radiological examination revealed a symptom complex of osteoarthrosis of both knee joints. Consulted by a rheumatologist - rheumatological tests are negative, the autoimmune nature of the disease is excluded. A clinical examination determined swelling in the area of both knee joints, pain during active and passive movements in them. On radiographs of both knee joints revealed a narrowing of the joint gap, the presence of osteophytes, signs of subchondral osteosclerosis. Conclusion: signs of osteoarthrosis of the II degree of both knee joints. Diagnosed with Osteoarthrosis, localized form. Bilateral gonarthrosis. " The following treatment was prescribed. An agitated suspension was prepared, for which they were mixed in a 1: 1: 1 ratio ointment Chondroxide 5%, Indomethacin 10% and Essaven gel. Each ointment and gel was squeezed out of the tube with a strip 10 cm long. Then, 50 mg of the powdered preparation Karipazim with an activity of 350 PE dissolved in 5 ml of physiological saline was added. A talker was applied to the skin over the area of both knee joints. Then they were exposed to ultrasound with an intensity of 0.4-0.6 W / cm ² for 5 minutes on the field. Ultraphonophoresis was performed daily for a course of 15 procedures. After 2 procedures, the patient began to notice a decrease in pain in the knee joints. By the end of treatment, the pain significantly decreased, the function in both knee joints improved. After the course of treatment, the pain was stopped, active and passive movements were carried out in almost full physiological volume.

Example 2. Patient W., 52 years old. From the anamnesis it is known that about 8 months ago, pains of a boring nature in the lumbosacral region, independent of the time of day, began to disturb. Over the next 2 months, their intensity gradually increased, the patient could not make turns of the body in full physiological volume due to pain. I did not receive treatment. In the last weeks before entering the hospital, he began to notice the appearance of paresthesia at the level of the left lower leg and foot, consisting in a feeling of numbness and crawling ants. They became difficult due to pains of movement of the spine around the horizontal axis. He sought medical help at the clinic at the place of residence, from where he was sent to a specialized hospital. He entered the clinic of traumatology and orthopedics. Clinical and radiological examination revealed a symptom complex of osteochondrosis of the lumbosacral spine. Objectively revealed the limitation of the volume of active and passive body movements around the sagittal and horizontal axes. The patient underwent MRI of the spine at the level of L _III -S _II . Conclusion: protrusion of the intervertebral discs L _III -L _IV without compression of the dural sac, signs of degenerative-dystrophic changes in the joints of the spine at the level of the lumbosacral region. According to the results of a clinical examination and MRI data, the diagnosis was made: "Osteochondrosis of the lumbosacral spine, pain. Sciatica. Stage of exacerbation. " The patient was given the following treatment. An agitated suspension was prepared, for which they were mixed in a 1: 1: 1 ratio ointment Chondroxide 5%, Indomethacin 10% and Essaven gel. Each ointment and gel was squeezed out of the tube with a strip 10 cm long. Then, 50 mg of the powdered preparation Karipazim with an activity of 350 PE dissolved in 5 ml of physiological saline was added. The talker was applied to the skin over the area of the pathology. Then, paravertebral exposure was provided by ultrasound with an intensity of 0.2-0.4 W / cm ² for 5 minutes on the field. Ultraphonophoresis was performed daily for a course of 12 procedures. After the third procedure, a decrease in pain was noted. By the middle of the treatment course, the pains decreased markedly, an increase in the amplitude of body movements around the horizontal and sagittal axes was noted. By the end of the course of treatment, the pain syndrome was completely stopped, the movements were restored in full physiological volume.

Example 3. Patient M., 25 years old. He turned in 2 hours after the injury - fell on the area of the right knee joint. Worried about pain at rest, swelling of the right knee joint, impaired supportability of the right lower limb. On examination, there was a hematoma in the region of the right knee joint, edema of periarticular tissues, severe pain on palpation, a positive symptom of ballotation of the patella, extension of the knee joint was incomplete due to pain. The left knee joint is apparently unchanged, there is no soreness. An X-ray examination of the right knee joint revealed no bone pathology. During puncture of the right knee joint, synovial fluid stained with blood was obtained in an amount of 15 ml. Blocked right knee joint. The diagnosis was made: “Closed trauma of the capsule-ligamentous apparatus of the right knee joint. Hemarthrosis. " After this, the patient was given a posterior plaster cast for a period of 2 days, then a right knee joint was punctured again, as a result of which 5 ml of synovial fluid stained with blood was obtained. Blockade of the right knee joint was again made. A 2-week rear plaster cast was applied. After removing the plaster cast, the patient was worried about: soreness and inability to move in full physiological volume in the right knee joint. The patient was treated: a shaken suspension was prepared, for which they were mixed in a 1: 1: 1 ratio of Chondroxide ointment 5%, Indomethacin 10% and Essaven gel. Each ointment and gel was squeezed out of the tube with a strip of 5 cm length. Then, 50 mg of the powdered preparation Karipazim with an activity of 350 PE dissolved in 5 ml of physiological saline was added. A talker was applied to the skin in the region of the right knee joint. Then they were exposed to low-frequency ultrasound with an intensity of 0.4-0.6 W / cm ² on the joint area up to 5 minutes on the field. Ultraphonophoresis was performed daily for a course of 15 procedures. After 2 procedures, pain at rest in the area of the right knee joint decreased, and after 4-5 procedures the pain syndrome when walking was significantly reduced. By the end of the course, edema of periarticular tissues was practically eliminated, there was no fluid in the joint cavity, the range of movements in the right knee joint was complete. The patient was recommended systematic exercise therapy, massage, as well as undergo a second course of treatment after 2 months to prevent the progression of degenerative changes in the joints.

Thus, the advantages of the proposed method are:

- The use of a complex of drugs administered by phonophoresis provides a simultaneous effect on various pathogenetic links of the pathological process. Indomethacin has a quick local analgesic, anti-inflammatory, decongestant effect. Chondroxide ointment, which is part of the Chondroxide ointment, has a long chondroprotective effect: it improves calcium and phosphorus metabolism in the cartilage and stimulates the synthesis of glucosaminoglycans, accelerates bone tissue regeneration and inhibits cartilage degeneration, inhibits the enzymes that cause damage to the cartilage tissue and promotes the regeneration of the articular cartilage and joints. Also included in the composition of the ointment "Chondroxide" dimethyl sulfoxide causes a quick local anti-inflammatory effect, is able to penetrate deep into the tissues and contribute to strengthening the direction of other drugs in inflamed tissues. Escin and heparin sodium salt, which are part of the Essaven gel, provide normalization of blood viscosity in the pathological focus, improve microcirculation, which helps to reduce edema, accelerates the restoration of cartilage tissue, potentiate anti-inflammatory effect, and have an analgesic effect. Caripazim, which has an antifibrotic effect, prevents the development of the scar-adhesive process in periarticular tissues and articular contractures. Used as a physical factor, low-frequency ultrasound has a synergistic effect with the injected drugs: it enhances local blood circulation, stimulates regeneration processes, and has anti-inflammatory, absorbable and analgesic effects.

- As a result of the rapid therapeutic effect when using the proposed method for the treatment of degenerative diseases of the musculoskeletal system and post-traumatic adhesions, the overall rehabilitation of patients is reduced, which indicates the economic efficiency of the method.

- In the treatment according to our proposed method, it is enough for the patient to receive one procedure per day, providing a sufficient clinical effect.

- When implementing the proposed method, a suspension of drugs containing Karipazim is applied directly to the skin in the affected area and is affected by low-frequency ultrasound, so the loss of the drug Karipazim is minimal. This allows you to use an expensive drug in lower dosages while maintaining its effectiveness.

Claims (1)

A method of treating degenerative diseases of the musculoskeletal system or post-traumatic adhesive processes in the joints, including applying chondroxide to the affected area of the ointment, characterized in that the chondroxide ointment is mixed with indomethacin ointment and essaven gel in a ratio of 1: 1: 1, adding 50 mg of enzyme the preparation of karipazim dissolved in 5 ml of physiological saline, the resulting suspension is applied to the affected area and ultrasonophoresis is carried out for 5 minutes per area, daily, in a course of 15-20 procedures.

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