RU2318554C1 - Method for treating osteoarthrosis cases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves starting magnetic laser therapy beginning from the second treatment day. Apparatus having magnetic head is used at frequency 80 Hz. Segmental vertebral column reflex region is irradiated. Paravertebral zones are irradiated in the vicinity of C5-D2 in predominant upper extremity articulation injury cases; in the vicinity of L1-S3 in predominant lower extremity articulation injury cases. Scanning method is applied with speed not exceeding 2 cm/s, spending 4 min for each field. Stable local radiation is applied to the most severely injured pair of articulations over articulation fissure projection zones spending 3 min for each zone during three days in succession. Then, magnetic laser therapy sessions are given every other day with hydrogen sulfide baths being added beginning from the fourth treatment day making 10 min long pauses between physiotherapeutic procedures. Amplipulse pelotherapy with silt mud enriched in hydrogen sulfide water having hydrogen sulfide concentration of 350 mg/l is applied to the same zones using Amplipulse apparatus. The total treatment course is 10 magnetic laser therapy procedures, 8 amplipulse pelotherapy and 8 balneo procedures long.

EFFECT: marked anti-inflammatory and anesthetic effectiveness; improved local and segmental trophic action; avoided adverse side effects.

9 tbl

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 in combination on days free of baths with laser therapy according to a segmental-local technique: paravertebral and local to the most affected joints [1].

However, the application of the known technique gives a positive clinical effect on average in 83.3% of cases with 8.3% of the balneopathological reaction.

The steady growth of diseases of the musculoskeletal system (BMMS) according to international statistics, including in Russia over the past 10 years by more than 1/3 with frequent disability and a significant decrease in quality of life, served as the basis for WHO to declare the current decade the International decade of bones and joints . According to medical statistics, in recent years, the incidence of OA has increased by 25%. Improving the prevention and quality of treatment of degenerative-dystrophic diseases, primarily non-drug methods, is an urgent public health problem.

The high efficiency of common hydrogen sulfide baths has been repeatedly demonstrated in various resort rehabilitation complexes for patients with OA. To enhance the therapeutic effect of the latter, the introduction of targeted drugs into the area of the most affected peripheral joints seems promising. Peloid therapy has long been one of the most important methods of treating patients with OA. Recently, interest in mud therapy has been focused on leveling its undesirable effects while increasing the bioavailability of chemical and biological components. There is experience in the therapeutic use of silt of medium mineralized weakly sulfide therapeutic mud in the Imereti Bay of the Adler region of Sochi, enriched in hydrogen sulfide mineral water, which increases the saturation with chemical components (hydrogen sulfide, trace elements) and increases the value of therapeutic mud in balneotherapy. Currently, there is a methodology for industrial processing and packaging of enriched therapeutic mud in the form of Goldpeloid packages. The general availability and ease of use makes it possible to expand, on the one hand, the possibilities of rehabilitation using the natural factors of the Sochi resort, and on the other hand, to bring it closer to the patients' place of residence by freely selling local therapeutic mud to other regions of Russia through the pharmacy network. The effectiveness of peloid therapy is increased by the phoretic introduction of the therapeutic components of the mud by pulsed sinusoidal modulated currents.

An urgent problem in increasing the effectiveness of the use of therapeutic mud is the development of methods that overcome the epidermal barrier for therapeutic components of mud with the summation of the pathogenetic therapeutic local effect. In particular, physical methods for potentiating the therapeutic effect of peloid therapy are currently being developed: electro-ultraphonophoresis of dirt, magnetopeloid therapy, etc. Laser radiation, in addition to non-specific biostimulating effects, slows down the destructive processes in the articular cartilage of patients with OA, has an immunomodulatory effect, and has a high adaptogenic focus. The permeability of the skin under the action of laser magnetic radiation increases. This fact makes it advisable to use sequential, close to combined, procedures of magnetolaser therapy and amplipulspeloid therapy.

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 determines the expediency of using segmental procedures in these cases.

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

The solution to this problem is achieved by the fact that starting from the 2nd day of treatment, they begin magnetic laser therapy from the Uzor-2K apparatus through a magnetic nozzle with magnetic induction of 20 mT, the maximum power in the pulse, irradiating the reflex-segmental region of the spine with a radiation frequency of 80 Hz: with primary damage joints of the upper extremities - paravertebral zones in the region of C5-D2, lower extremities - L1-S3 according to a scanning technique with a speed of not more than 2 cm per second, lasting 4 minutes on the field and local stable radiation the most affected pair of joints in the zones of projection of the joint space for 3 minutes per zone for three consecutive days, then every other day with hydrogen sulfide baths, connecting from the 4th day of treatment, with an interval of up to 10 minutes between physiotherapy, amplipulspeloid therapy of silt mud enriched with hydrogen sulfide water at a concentration hydrogen sulfide 350 mg / l, the same zones from the Amplipulse-5 apparatus, for a course of 10 procedures of magnetic laser therapy, 8 procedures of amplipulse speloid therapy and 8 balneotherapy.

The method is as follows. From the second day of your stay at the resort, the procedures of magnetic laser therapy are carried out daily for 3 days. Patient position - lying on a couch or sitting on a chair. The radiation from the Uzor-2K apparatus through a magnetic nozzle with magnetic induction of 20 mT, the pulse power is maximum, with a radiation frequency of 80 Hz. The procedure begins with irradiation of segmental zones: with a primary lesion of the joints of the upper extremities on the paravertebral zones in the region of C5-D2, lower limbs - L1-S3. The exposure technique is contact, labile, with scanning movements at a speed of not more than 2 cm per second, lasting 4 minutes in the field. Next - local exposure to the most affected pair of joints. The exposure technique is contact, stable, according to the traditional zones of the projection of the joint space (V.E. Illarionov. Technique and methods of laser therapy procedures. Reference book. - M., 1994, p. 61-65) for 3 min per zone, acting simultaneously on two zones. Not more than 10 minutes after the 3rd procedure of magnetic laser exposure, the procedure of amplipulspelioiodotherapy is carried out sequentially. Silt mud enriched with hydrogen sulfide water at a concentration of hydrogen sulfide 350 mg / l, pre-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-lining with a thickness of 1-2 cm. The exposure is carried out on the reflex-segmental region of the spine and on the area of the two most affected joints exposed to magnetic laser therapy using a low-frequency physiotherapy apparatus Amplipuls-5 and a set of standard plate lead electrodes, their corresponding gauze hydrophilic gaskets and envelopes with silt mud of Imereti origin (Sochi ) enriched with hydrogen sulfide water.

The procedure is released in two stages, successively one after another without interruption:

- the first stage - the impact on the corresponding reflex-segmental paravertebral zones (in case of damage mainly to the upper extremities at the level of C5-Th3, lower extremities - the level of L2-S1) with simultaneous amplipulspeloidophresis. At the same time, silt mud enriched with hydrogen sulfide water at a concentration of hydrogen sulfide of 350 mg / l is preheated in a water bath to a temperature of 36-38 degrees. The required amount of dirt (200-250 ml) is placed on a cloth, formed with an envelope with a thickness of 1-2 cm and laid on the corresponding paravertebral zone on the right and left with fixation over standard electrodes of size (4 + 12) cm. Operation mode, type of work, frequency and depth of modulations, range, duration of the packages, exposure time are shown in table 1.1 and 1.2. The current strength is set at a level at which the patient feels a pronounced painless vibration.

- the second stage - they have a local effect on the most affected joints with simultaneous amplipulspeloidophoresis. Pre-prepared two mud (silt mud enriched with hydrogen sulfide water at a concentration of hydrogen sulfide 350 mg / l) envelope-laying with fixing standard plate electrodes (4 + 8) cm on top of them is placed on each joint. Not more than two of the most affected joints are exposed. The parameters of the vacation procedures are shown in table 2.

Table 1.1. Amplipulspeloidophoresis on paravertebral reflexogenic zones of the upper limbs sequence of procedure operating mode parcel duration per second occupation modulation frequency in Hz modulation depth in% export time in minutes one rectified 2-3 I 150 0 2 III 150 0 2 2 ------ 2-3 III one hundred 25 3 IV one hundred 25 3 3 ---- 2-3 III one hundred 25 3 IV one hundred 25 3 four --- 2-3 III 80 fifty four IV 80 fifty four 5 --- 2-3 III 80 fifty four IV 80 fifty four 6 and subsequent --- 2-3 III 80 25 3 IV 80 25 3

Table 1.2. Amplipulspeloidophoresis on the reflexogenic zones of the lower extremities sequence of procedure operating mode parcel duration per second occupation modulation frequency in Hz modulation depth in% export time in minutes one rectified 2-3 I 150 25 3 III 150 25 3 2 ------ 2-3 III one hundred 25 3 IV one hundred 25 3 3 ---- 2-3 III one hundred fifty four IV one hundred fifty four four --- 2-3 III 80 75 four IV 80 75 four 5 --- 23 I 80 fifty four IV 80 fifty four 6 and subsequent --- 2-3 III 80 25 3 IV 80 25 3

Table 2. Amplipulspeloidophoresis according to a local technique (to the area of affected joints) sequence of procedure operating mode parcel duration per second occupation modulation frequency in Hz modulation depth in% export time in minutes one rectified 2-3 I one hundred 25 5 III one hundred 25 3 2 ------ 2-3 III 80 fifty 5 IV 80 fifty 5 3 ---- 2-3 III fifty fifty 5 IV fifty fifty 5 four --- 2-3 III thirty 75 5 IV fifty 75 5 5 --- 2-3 I thirty 75 5 IV thirty 75 5 6 and subsequent --- 2-3 III fifty fifty 5 IV fifty fifty 5

Table 3. The treatment regimen for the proposed method days of treatment Procedures one. climatotherapy, exercise therapy, massage 2. climatotherapy, exercise therapy, massage, MIL therapy 3. climatotherapy, exercise therapy, massage, MIL therapy four. climatotherapy, exercise therapy, massage, MIL therapy + amplipulspeloid therapy 5. climatotherapy, exercise therapy, massage, WWS 50 mg / l, З6 city., 6 min 6. climatotherapy, exercise therapy, massage, MIL therapy + amplipulspeloid therapy 7. climatotherapy, exercise therapy, massage, WWS 50 mg / l, 36 deg., 8 min 8. climatotherapy, exercise therapy, massage, MIL therapy + amplipulspeloid therapy 9. climatotherapy, exercise therapy, massage, WWS 100 mg / l, 36 deg., 10 min 10. climatotherapy, exercise therapy, massage, MIL therapy + amplipulspeloid therapy eleven. climatotherapy, exercise therapy, massage, WWS 100 mg / l, 36 deg., 12 min 12. climatotherapy, exercise therapy, massage, MIL therapy + amplipulspeloid therapy 13. climatotherapy, exercise therapy, massage, WWS 150 mg / l, 36 deg., 15 min fourteen. climatotherapy, exercise therapy, massage, MIL therapy + amplipulspeloid therapy fifteen. climatotherapy, exercise therapy, massage, WWS 150 mg / l, 36 deg., 15 min 16. climatotherapy, exercise therapy, massage, MIL therapy + amplipulspeloid therapy 17. climatotherapy, exercise therapy, massage, WWS 150 mg / l, 36 deg., 15 min eighteen. climatotherapy, exercise therapy, massage, MIL therapy + amplipulspeloid therapy 19. climatotherapy, exercise therapy, massage, WWS 150 mg / l, 36 deg., 15 min - final examination. Note: OSV - general hydrogen sulfide baths, MIL therapy - magneto-infrared laser therapy

An example of a specific implementation of the method.

Patient U., 42 years old, has been suffering from polyosteoarthrosis with a predominant lesion of the knee joints for 4 years, Ro-2 tbsp., Federal Tax Service 1-2, with concomitant osteochondrosis of the lumbar spine with severe pain, obesity 1 tbsp. During the last year, she was hospitalized twice in connection with exacerbations of the articular syndrome, synovitis of the right 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 a course of treatment according to the proposed method (amplipulspeloidophoresis on the lumbosacral region and the area of the knee joints on the background of hydrogen sulfide balneotherapy). Tolerability of the procedures was good. After taking 3-4 procedures of amplipulspeloidophoresis, the patient completely stopped lumbalgia, after 5-6 procedures, the range of movements in the knee joints markedly 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 transition was observed from the reaction of "calm activation" to a more intense reaction of "increased activation". The protective effect on the metabolic processes of connective tissue was confirmed by biochemical studies: the catalase activity of blood plasma significantly decreased from 38.6 μkat / L to 26.0 μkat / L, which was accompanied by a decrease in the number of medium-molecular peptides from 0.310 conventional units. up to 0.180 conventional units; acid mucopolysaccharides with 0.235 units. to 0.217 units, the level of ceruloplasmin decreased from 0.366 g / l to 0.228 g / l, which indirectly indicates a decrease in proteolysis processes under the influence of the proposed treatment complex. Normalized and indicators of lipid peroxidation and antioxidant protection: diene conjugates of blood plasma decreased from 4.53 conventional units. up to 2.69 conventional units, erythrocyte malondialdehyde - from 57.82 nmol / ml er.mass to 48.35 nmol / ml er.mass, the amount of lipid malondialdehyde varied within the normal range. The anti-inflammatory effect of the complex was confirmed by a change in the PSA from trace indicators to negative. 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 initially reduced rheographic index of the right lower leg normalized (from 0.18 to 0.7, the norm is 0.70-1.00), the reographic coefficient changed from 17% to 12% (the norm is 9-14%); significantly increased the average rate of vascular filling from 0.12 to 0.58 OM / s, although it did not reach normal values (0.7-1.0 Ohm / s). This happened both due to the normalization of the average speed of fast filling (from 0.11 to 0.94 Ohm / s), and due to the increase in the average speed of slow filling (from 0.16 to 0.49 Ohm / s); the dicrotic index normalized from 0.33 to 0.54 (the norm is 0.5-0.7); venous outflow on the right lower leg decreased from 41% to 30% (normal - up to 20%). The rheographic parameters of the left tibia varied within normal limits. Survey results (SAN questionnaire) revealed an increase in total activity indicators from 9 to 17 points, moods from 5 to 12 points, anxiety level - 8 points did not change. The McGill questionnaire objectively demonstrated a decrease in the intensity and emotional staining of arthralgia: the total number of descriptors decreased from 8 to 3, the total amount of ranks from 16 to 5. The visual-analogue scale confirmed the transition of pain from the “strongest” (8 points) to the “moderate” "(4 points).

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

A total of 82 patients with osteoarthritis (M15-M19, ICD-X) were treated, stages 1-2 according to N.S.Kosinskaya, impaired function of joints of the 0-1 degree, aged 26 to 59 years. The disease duration averaged 6.5 years. Against the background of the main medical complex, which includes a gentle-training regimen of physical activity, morning and medical gymnastics, climatic procedures are 1 each with a transition to 2 modes, common hydrogen sulfide baths dispensed every other day (concentration of 50-100-150 mg / l, 36 degrees, 6 -8-12-15 minutes, 8 baths per course):

Patients of group 1 (prototype) - 24 people - on days free of baths received laser therapy procedures for reflex-segmental zones and locally on one / two of the most affected joints.

Group 2 (control) - 33 patients - received amplipulspelioiodotherapy on bath-free days, on reflex-segmental zones and locally on one / two more affected joints.

Group 3 (the proposed method) - 25 patients received, on days free of baths, a treatment complex consisting of sequential procedures of magnetic laser therapy and amplipulspeloid therapy for reflex-segmental zones and locally for one / two most affected joints with an interval of up to 10 minutes per course 10 physical and 8 balneological procedures.

The effectiveness of complex therapy was evaluated by the dynamics of clinical data, the degree of arthralgia and its structure - according to 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 Kerdo index indicated the dynamics of the state of the autonomic nervous system. Biochemical studies included determining the level of fibrinolytic activity of plasma, fibrinogen and 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. Blood catalase level characterized the activity of the body’s own antioxidant system, diene conjugates, malondialdehyde in red blood cells and lipids — a state of lipid peroxidation. 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 4): improvement in the condition of patients was noted in 100% of cases against 83.3% in the prototype group. Moreover, due to "significant improvement" - 56.0% against 33.3% in the prototype and 24.0% in the control group. At the same time, the stress of the treatment complex was not noted, which is confirmed by a 2-fold decrease in the number of cases of early balneopathological reaction (4% versus 8% in the prototype and control group).

At the end of the course of complex therapy, patients noted an improvement in overall health, relief of pain with an increase in range of motion. In particular, a pronounced limitation of the range of motion in the joints in the initial state in 18 (72%) patients by the end of the course of treatment was preserved in only one patient due to 12 (48%) cases of transition to moderate limitation of movement and normalization in 20% of cases. The magnetolaser component in the proposed treatment complex, as well as in the prototype, had a pronounced positive effect on articular inflammation: by the end of the course of treatment, the number of cases with reactive synovitis decreased by 48.0% and 47.4%, respectively. The positive dynamics of periarticular changes was more significant in the proposed resort complex - 66.6% of cases against - 21.0% in the prototype.

The analgesic effect of the studied treatment complexes is objectively reflected in table 5. The results of the survey indicate a more pronounced analgesic effect of the proposed method of treatment: the sum of the ranks of pain was significantly reduced - Δ12.9 versus Δ7.6 in the prototype. Moreover, an analysis of the structure of the pain syndrome indicates a decrease in the predominantly sensory qualities of pain.

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 magnetic laser exposure and galvanopeloid therapy on reflex paravertebral zones with trophic effects on the peripheral nervous system and, as a consequence, peripheral hemodynamics. This is confirmed by significant shifts in a number of biochemical parameters and rheographic parameters of limb vessels (Table 6). The laser component eliminates the effect of suppressing fibrinolysis by hydrogen sulfide baths, and in the proposed complex, unlike the prototype, the lysis time of globulin clots does not systematically decrease, but normalizes from initially high or low values (Table 1). In the group of patients who received the proposed method of treatment, there was a significant decrease in the number of medium molecules from 0.291 ± 0.008 to 0.267 ± 0.008 units. It should be noted the reliable normalizing effect of the proposed treatment complex on the content of lipid peroxidation products (Table 2.1). At the same time, the advantage of a consistent, close to combined technique of amplipulspeloid and magnetic laser therapy is not only a positive trophic effect, but also the containment of destructive processes in the connective tissue. This fact is confirmed by the detected tendency to a decrease in the values of diene conjugates from 2.94 ± 0.21 to 2.74 ± 0.25 units, a reliable normalization of the amount of MDA in red blood cells and in lipids with their initial increase (Table 2.1), which leads to the corresponding dynamics of AOS indicators: with an initially high catalase content, its significant decrease from 45.1 ± 1.8 to 30.1 ± 2.0 microns cat / l.

The normalization of the state of the autonomic nervous system in the studied groups by the end of the course of therapy manifested itself in the dynamics of indicators of a wedge-orthostatic test (CPC): the number of patients with a normotonic variant of CPC after treatment with the proposed method increased by 1.4 times, while in the control group - by 1 2. Complex spa therapy favorably affected the state of the compensatory-adaptive forces of the body (Table 7). In the group of patients treated by the proposed method, the number of “training reactions” increased to 28.6%, which indicates the absence of stressful effects of the studied medical complex. The results of the analysis of the “state self-assessment” questionnaire indicate the advantage of the proposed complex: by the end of the course of treatment, the “activity” of patients significantly increased by 7.2 points versus 5.7 points in the control and the dynamics of the “mood” indicator did not differ significantly compared to the control group.

Thus, in cases of osteoarthrosis, regardless of the stage of the disease during complete or incomplete remission in combination with osteochondrosis of the spine, the appointment of a comprehensive spa treatment with a course of hydrogen sulfide balneotherapy in combination with the sequential effect of segmental-local procedures of magnetolaser and amplipulspeloid therapy provides pronounced anti-inflammatory, analgesic effects, positive local and segmental trophic effects with phenomena of improvement of the peripheral and autonomic nervous systems, peripheral blood circulation, which is manifested by an increase in the therapeutic effectiveness of spa rehabilitation of patients by an average of 8-16.7% in a period shortened to 19 days while the treatment complex is not stressed.

Table 2.1 The dynamics of lipid peroxidation and antioxidant protection in patients with osteoarthritis INDICATORS Group Total lipids g / l Diene conjugates units MDA in erythrocytes n mol / L MDA in lipids Catalase MK Cat / L Ceruloplasmin g / l Prototype (n = 24) 3.95 ± 0.11
4.04 ± 0.15 2.7 ± 0.2 *
2.2 ± 0.2 53.1 ± 1.8 *
45.7 ± 1.4 14.1 ± 0.5
13.5 ± 0.5 26.9 ± 2.5 *
33.8 ± 2.6 0.31 ± 0.012 *
0.249 ± 0.011 Control group (n = 33) 4.99 ± 0.27 *
5.62 ± 0.21 4.38 ± 0.26
4.58 ± 0.27 42.21 ± 2.09
41.48 ± 1.62 8.99 ± 0.71 *
7.55 ± 0.47 27.56 ± 1.96
29.17 ± 2.61 0.338 ± 0.012 *
0.419 ± 0.013 The proposed method (n = 25) 5.33 ± 0.22
5.25 ± 0.24 2.74 ± 0.28
2.94 ± 0.31 (initial indicators are higher than normal;
54.08 ± 2.30 *
25.71 ± 4.20 (baseline above normal)
10.45 ± 0.44 *
4.51 ± 0.41 38.80 ± 2.70 *
35.00 ± 1.65 0.347 ± 0.009
0.316 ± 0.009 (baseline below normal)
27.61 ± 1.71 *
42.0 ± 5.43 (baseline below normal)
6.82 ± 0.29 *
10.51 ± 1.02 (initial indicators are higher than normal,
45.1 ± 1.8 *
30.1 ± 2.0 Healthy 6.60 ± 0.39
4.00-8.00 1.56 ± 0.14
1.06-2.06 39.5 ± 0.92
35.0-43.4 8.35 ± 0.08
8.05-8.65 16.8 ± 0.017
10.6-23.0 0.340 ± 0.009
0,300-0,380 Note. In the numerator - an indicator before treatment. In the denominator is the indicator after treatment. * - sign of significant difference p <0.05

Table 4 Therapeutic efficacy of the proposed treatment complex in patients with osteoarthrosis The effectiveness of treatment (in% of the number of patients) Prototype N = 24 Control N = 25 The proposed method N = 25 Significant improvement 33.3 24.0 56.0 Improvement 41.7 48.0 28.0 Slight improvement 8.3 20,0 16,0 no change 16.7 8.0 0 % balneopathological reaction 8.3 8.0 4.0

Table 5 Change in pain indicators in patients with polyosteoarthrosis under the influence of various treatment complexes Indicators / lay down. complexes Prototype The control The proposed method "YOUR" - 5.2 ± 0.3
1.7 ± 0.3 5.3 ± 0.3
2.4 ± 0.3 Touch scale Number of descriptors 3.8 ± 0.4
2.1 ± 0.2 5.5 ± 0.7
2.8 ± 0.3 5.5 ± 0.7
2.8 ± 0.3 Sum of ranks 10.0 ± 1.3
4.4 ± 0.6 13.9 ± 1.3
5.3 ± 0.7 13.9 ± 2.1
5.3 ± 0.7 Affective scale Number of descriptors
Sum of ranks 3.5 ± 0.2
2.2 ± 0.2
7.0 ± 0.7
3.2 ± 0.4 3.6 ± 0.3
2.2 ± 0.2
6.9 ± 0.7
3.6 ± 0.4 3.6 ± 0.3
2.2 ± 0.2
6.9 ± 0.7
3.6 ± 0.4 Evaluation Scale Sum of ranks 2.5 ± 0.1
1.5 ± 0.1 2.5 ± 0.1
1.5 ± 0.1 2.6 ± 0.1
1.6 ± 0.1 Total number of descriptors 7.1 + 0.4
5.0 + 0.2 9.1 ± 0.8
5.0 ± 0.5 9.07 ± 0.8
5.0 ± 0.5 Total Ranks 11.3 + 0.5
3.7 + 0.4
Δ7.6 23.3 ± 1.9
10.4 ± 1.0
Δ12.9 23.4 ± 2.5
10.5 ± 1.05
Δ12.9 Note: In the numerator is the indicator before treatment. In the denominator is the indicator after treatment. The change in all indicators is significant (P <0.05).

Table 6 Changes in rheovasography of limbs in patients with osteoarthritis under the influence of spa treatment Group Reographic index Reographic coefficient Before treatment After treatment Before treatment After treatment Prototype 1.0 ± 0.05
1.1 ± 0.06 1.0 ± 0.05
1.0 ± 0.04 13.1 ± 0.5
14.2 ± 0.5 17.0 ± 0.6 *
14.8 ± 0.4 Control 0.48 ± 0.02
0.52 ± 0.02 0.56 ± 0.03 *
0.59 ± 0.03 * 19.40 ± 1.95
19.90 ± 1.47 14.14 ± 1.61 *
14.03 ± 0.64 * The proposed method 0.48 ± 0.02
0.52 ± 0.02 0.56 ± 0.03 *
0.59 ± 0.03 * 19.40 ± 1.95
19.90 ± 1.47 14.14 ± 1.61 *
14.03 ± 0.64 * Note. In the numerator is the indicator on the right. The denominator is on the left. * - sign of significant difference p <0.05

Table 7 The dynamics of the adaptation reaction (number of patients in percent) Group Training Calm activation Increased activation Prototype 20.8
33.3
Δ + 12.5 20.8
33.3
Δ + 12.5 33.3
20.8
Δ-12.5 Control 4.0
8.0
Δ + 4.0 72.0
60.0
Δ-12.0 24.0
32,0
Δ + 8.0 The proposed method 14.3
28.6
Δ + 14.3 28.57
28.57
Δ0 57.1
42.9
Δ-14.2

Information sources

1. Ibadova T.D. and others. Integrated hydrogen sulfide laser therapy in patients with osteoarthritis. Guidelines. Sochi, 1994 .-- 15 s

Claims (1)

A method of treating osteoarthrosis by means of hydrogen sulfide balneotherapy every other day, and exposure to a physical factor, characterized in that from day 2 of treatment they begin magnetic laser therapy from the Uzor-2K apparatus through a magnetic nozzle with magnetic induction of 20 mT, the maximum pulse power with a radiation frequency 80 Hz, irradiating the reflex-segmental region of the spine: with a primary lesion of the joints of the upper limbs - paravertebral zones in the region of C5-D2, lower limbs - L1-S3 according to a scanning technique from soon Tew no more than 2 cm per second, lasting 4 minutes on the field and local stable irradiation of the most affected pair of joints in the zones of projection of the joint space for 3 minutes per zone for three consecutive days, then every other day with hydrogen sulfide baths, connecting from the 4th day of treatment, with an interval of up to 10 min between physiotherapy, amplipulspeloid therapy of silt mud enriched with hydrogen sulfide water at a concentration of hydrogen sulfide 350 mg / l, the same zones from the Amplipuls-5 apparatus, for a course of 10 procedures of magnetolaser therapy, 8 procedures of amplipulspeloid therapy and 8 balneological procedures.