RU2318548C2 - Method for applying upper extremity nerves and muscles electrostimulation in distal forearm bone fracture cases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves recording electric neuromyogram of injured and contralateral extremity as well as electric neuromyogram taken from intact extremity with magnetograph device. Brachial plexus and great blood vessels electrostimulation are treated on injured extremity in the following mode. Frequency of 1-9 Hz, signal duration of 2-4 s, voltage 50-500 V, current intensity of 20 tA are selected within 7-10 min long session. Then, injured extremity muscles stimulation is carried out using electric neuromyograms of injured extremity recorded with magnetograph device. Bilateral injury being the case, direct electrostimulation control from donor or stimulation control from built-in program synthesizer operating with pulsating bipolar rectangular current of modulation frequency equal to 40-240 Hz, pulse duration of 200-500±10% ms, session duration of 15-20 min with 5 channels operating at the same time. The number of sessions is 10-15, the number of treatment cycles is 2-3 with 1.5-2 months long pauses.

EFFECT: enhanced effectiveness of treatment.

2 cl

Description

The method relates to medicine, namely to traumatology and orthopedics.

A known method of muscle stimulation using sinusoidal modulated currents Yasnogorodsky (1).

The disadvantage of this method is the incomplete effect on the damaged limb, which reduces the effectiveness of the treatment.

There is also known a method of muscle stimulation using mid-frequency modulated pulse current (2).

The disadvantage of this method is the limited effect on the neuromuscular apparatus and a decrease in treatment results.

The aim of the invention is to increase the efficiency of electrical stimulation of nerves and muscles of the injured upper limb, to improve the treatment results of patients with fractures of the distal forearm bones and reduce its time.

This goal is achieved by the fact that prior to stimulation, the electroneuromyogram of the damaged and contralateral limbs is recorded, as well as the recording of the electroneuromyogram of the intact limb on a magnetograph; conduct electrical stimulation of the brachial plexus and the main nerves of the damaged upper limb in the following mode: frequency 1–9 Hz, signal duration 2–4 ms, voltage 50–500 V, current strength 20 mA, session duration 7–10 min; after which they perform stimulation of the muscles of the damaged limb: in case of unilateral damage - with the help of electroneuromyograms of the intact limb recorded on a magnetograph; in the case of bilateral damage, “direct” control of stimulation from the donor or control of stimulation from the built-in program synthesizer is carried out in the mode: pulse bipolar rectangular current with a modulation frequency of 40 to 240 Hz, pulse duration from 200 to 500 ms ± 10%; the duration of the session is 15-20 minutes, 5 channels at a time, the number of sessions is from 10 to 15, the number of treatment cycles is 2-3, with an interval between them of 1.5-2 months, and the brachioradial muscle, radial flexor of the wrist are stimulated, short abduction of the thumb, ulnar extensor of the wrist, common extensor of the fingers, the first dorsal interosseous, superficial flexor of the fingers (as in claim 2 of the formula).

The method is implemented as follows.

The electroneuromyogram of the injured and contralateral limbs is recorded on the Nicolet / Viking Quest myograph, as well as the electroneuromyogram of the muscles of the intact limb on the magnetograph. After that, electrical stimulation of the brachial plexus and the main nerves of the damaged upper limb is performed in the following mode: frequency 1–9 Hz, signal duration 2–4 ms, voltage from 50 to 500 V, current strength 20 mA, session duration 7–10 min.

On the apparatus "Myoton-604", with cutaneous electrodes of 4 cm ² , the following muscles of the damaged limb are stimulated: brachioradial, radial flexor of the wrist, short abduction of the thumb, ulnar extensor of the wrist, common extensor of the fingers, first posterior interosseous, superficial flexor of the fingers. In case of unilateral damage, electrical stimulation is controlled using electroneuromyograms of an intact limb recorded on a magnetograph. In the case of bilateral damage, “direct” control of stimulation from the donor or stimulation control from the built-in program synthesizer is carried out in the mode: pulse bipolar rectangular current with a modulation frequency from 40 to 240 Hz, pulse duration from 200 to 500 ms ± 10%; the duration of the session is 15-20 minutes, 5 channels at a time, the number of sessions is from 10 to 15, the number of cycles is 2-3, with an interval between them of 1.5-2 months.

Clinical example. Patient L., born in 1955, medical history No. 25029041, was admitted to the Department of Orthopedics-2 SOKB them. M.I. Kalinina September 12, 2004 with a diagnosis of abnormally fused extensor fracture of the distal metaepiphysis of the right radius The injury was received on July 27, 2004. 7 weeks have passed since the injury. 09/13/04 the operation was performed: imposition of an external fixation apparatus on the right forearm and hand. Bone fragments (10–11 mm) were distracted for 7 days. September 20, 2004, the external fixation apparatus was dismantled with simultaneous open reposition and osteosynthesis of the radial bone with the back LCP plate (AO-titanium). In the postoperative period, electrical stimulation of the neuromuscular apparatus of the damaged limb was performed according to the proposed method. At the follow-up examination after 6 weeks, the average amplitude of the M-response of the muscles of the damaged limb increased by 51% compared with preoperative parameters, and after 6 months - 3 times. The restoration of the bioelectric activity of the muscles of the damaged limb was more complete than in patients with a similar injury who did not receive electrical stimulation. The total range of movements in the wrist joint was 71.5% of the contralateral limb, and gross grip strength was 59%, which was 15-20% higher than in patients in the control group. According to the results of objective and subjective assessment criteria, the result of treatment is recognized as "good." 1 year after the operation, an “excellent” treatment result was observed.

The proposed method can and should be used in the treatment of patients with fractures of the distal forearm bones in hospitals with an orthopedic profile, as well as in outpatient settings. Its use will improve the functional state of the peripheral nerves of the upper limb, increase muscle strength and range of motion in joints, accelerate restoration of hand function and improve treatment results.

Information sources.

1. Yasnogorodsky V.G. Sinusoidal modulated currents and their therapeutic application. - Questions of balneology, 1969. - No. 6. - S. 481-487.

2. Matev I. B., Banks S. D. Rehabilitation for injuries to the hand. - Sofia, "Medicine and Physical Education". - 1981. - S. 129-130.

Claims (2)

1. The method of electrical stimulation of nerves and muscles of the upper limb during fractures of the distal bones of the forearm by exposure to electric current, characterized in that prior to stimulation they record the electroneuromyogram of the damaged and contralateral limbs, as well as record the electroneuromyogram of the intact limb on a magnetograph; conduct electrical stimulation of the brachial plexus and the main nerves of the damaged upper limb in the following mode: frequency 1–9 Hz, signal duration 2–4 ms, voltage 50–500 V, current strength 20 mA, session duration 7–10 min; after which they perform stimulation of the muscles of the damaged limb: in case of unilateral damage - with the help of electroneuromyograms of the intact limb recorded on a magnetograph; in the case of bilateral damage, “direct” control of stimulation from the donor or control of stimulation from the built-in program synthesizer is carried out in the mode: pulse bipolar rectangular current with a modulation frequency of 40 to 240 Hz, pulse duration from 200 to 500 ms ± 10%; the duration of the session is 15-20 minutes, 5 channels at a time, the number of sessions is from 10 to 15, the number of treatment cycles is 2-3, with an interval between them of 1.5-2 months. 2. The method according to claim 1, characterized in that electrical stimulation of the following muscles of the injured limb is performed: brachioradial, radial flexor of the wrist, short abduction thumb, ulnar extensor of the wrist, common extensor of the fingers, first posterior interosseous, superficial flexor of the fingers.