RU2357769C1 - Method of treatment for children undergone operation for scoliosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, particularly pediatrics and orthopedics, and can be applied in medical institutions for treatment of children with scoliosis. Method involves application of impulse magnetic field with 800-900 mTl intensity, 120-180 ms intervals between impulses, 4 impulses per parcel, to children undergone operation on 3-4 grade scoliosis, for 9 minutes at each side. The course comprises 10-12 daily procedures.

EFFECT: consolidated muscular support, ie normalised functioning of neuromuscular apparatus, pain syndrome elimination, positive influence on respiratory and cardiovascular systems, accelerated circulation processes and spinal muscle trophism, resulting in improved functional parametres of locomotor apparatus, which in turn facilitates prevention of disease progress, enhancement of complex rehabilitation efficiency for children with III-IV grade scoliosis in post-operation period, improved life quality for children and adolescents.

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Description

The present invention relates to medicine, in particular to pediatrics, namely to orthopedics, and can be used in medical institutions for the treatment of children with scoliosis.

It is known that currently the treatment of scoliosis in children is complex, aimed primarily at increasing the functional state of the muscle corset, neuromuscular system, normalizing metabolic and hormonal disorders in the connective tissue, leading to pathological changes in the intervertebral discs, eliminating decompensation and the fight against the progression of the pathological process. Therapeutic measures include compliance with the orthopedic regimen, wearing a corset, the use of factors of physiotherapy and balneotherapy.

The main disadvantages of existing methods of treating scoliosis are the excessive duration of treatment with simultaneous significant physical exertion, their repeated frequency, which requires considerable volitional efforts on the part of the child, which, in turn, entails rapid fatigue and the occurrence of adverse reactions. As a result, the degree of effectiveness of the treatment is reduced. In addition, not all methods of apparatus physiotherapy are applicable in the postoperative period, since during the operation the child is set up with a titanium two-plate dynamic endocorrector.

The need for surgical intervention for scoliosis of the III-IV degree determines the urgency of the problem of postoperative rehabilitation of such patients with the help of physical factors (Popov V.V., Khan M.A. 2004).

The modern treatment of scoliotic disease in the postoperative period necessarily includes therapeutic physical culture and massage. However, in order to increase the effectiveness of the comprehensive rehabilitation of such patients, pathogenetically substantiated is the use of methods of stimulation of the back muscles with the help of hardware exposure.

Of the physiotherapeutic methods, methods are known for treating scoliosis in children by applying factors such as exposure to low frequency direct current and drugs introduced with its help, for example, calcium phosphorus electrophoresis on the spinal region or according to Vermel’s technique. Electrodes with an area of 150 cm are located above and below the arc of the spine, the current density is 0.02-0.04 mA / cm ² , lasting 15 minutes, daily or every other day, for a course of 12-15 procedures (Umarova Kh.T., Karachevtseva T. B. Physiotherapy in pediatrics, 1993). However, this method has several disadvantages in the form of a pronounced irritating effect under the electrodes, which causes a negative reaction of the child, also with this method, there are large energy losses during the passage of the epidermis and a significant negative point is the possibility of allergic reactions to the medication used. In addition, there is no unequivocal opinion on the appropriateness, validity of the use of this method in children in the postoperative period of scoliosis, since in the area of application of the electrodes, under them, there is a titanium structure.

In order to accelerate metabolic processes, ultraviolet irradiation is used, general according to the main scheme (1/4 to two biodoses, for a course of 16-20 procedures, this course is carried out in the autumn-winter period (Umarova Kh.T., Karachevtseva T.V. Physiotherapy in pediatrics , 1993). However, with these exposure options, the desired degree of strengthening of weakened muscles is not achieved.

One of the most popular methods for treating scoliosis is the use of rectangular and diadynamic currents, which consists in electrical stimulation of the back muscles. The procedures are carried out from the Stimul-1 apparatus, frequency 50 Hz, duration of current deliveries 10 s, pauses - 20 s, current strength — until a sensation of pronounced, painless vibration lasts 5-10 minutes, daily or every other day, course 10-15 procedures, or electro-gymnastics with the help of the Amplipulse 4; 5 apparatus, where a non-rectified mode, 2 types of operation, a modulation frequency of 30 Hz, a depth of 75-100%, a parcel duration of 2-3 s, a procedure duration of 4-12 minutes are used. The current strength is selected individually until a feeling of vibration. The course of treatment is from 10-15 to 25-30 procedures (Umarova Kh.T., Karachevtseva T.V. Physiotherapy in pediatrics. 1993).

The closest in technical essence to the present invention is a method for the treatment of scoliosis in children, based on the use of interference currents, with a rhythmically changing frequency of 25-50 Hz, paravertebral to the projection area of the scoliotic arc from 2 pairs of electrodes, current from 5-25 mA before the sensation of vibration, the exposure time of 7-10 minutes (Patent invention No. 2238114 "Method for the treatment of scoliosis in children").

The disadvantages of this method are the inability to use it in children operated on for scoliosis of 3-4 degrees, due to the presence of a metal structure in the proposed area, which is a contraindication for electrical stimulation, as well as the likelihood of addiction due to the use of constant frequencies, the lack of the most accurate effects on the pathological zone, the occurrence of an irritating effect under the electrodes and the development of allergic reactions are not ruled out.

The technical result of the proposed method is to increase muscle tone, contributing to the creation of a stronger muscle corset, eliminating pain, improving blood supply, metabolic processes and trophism of the muscles of the trunk and, as a result, improving the functional indicators of the state of the musculoskeletal system, which, in turn, helps to prevent progression diseases.

The specified technical result is achieved by exposing the patient to a high-frequency pulsed magnetic field from the AMT 2 - “AGS” apparatus, with an intensity of 800-900 mT, intervals between pulses from 120 to 180 ms, 4 pulses in the package, inductors N and S are placed directly on the skin paravertebrally, according to a labile technique, in this case, every 2-3 pulses, the more active inductor S moves along the spine, and the inductor N is immovably located in the lumbar region, the power of exposure is until the muscles contract painlessly, the exposure time is 9-12 minutes on each side, per course of 10 procedures.

In this method of treatment, an intensity of 800-900 mT is used, which is optimal for use on the thoracic, thoracolumbar spine, has a pronounced myostimulating, analgesic, trophic effect, stimulates regeneration processes in damaged tissues, and also has anti-edematous and anti-inflammatory effects, which is especially important in the postoperative period of rehabilitation of children with scoliosis of 3-4 degrees.

The main advantages of magnetic stimulation over electrical are non-invasive effects, the absence of skin irritation and stimulation of its pain receptors. When pulsed magnetic stimulation occurs much deeper than during electrical stimulation, penetration into tissues and effects on cell membranes. Impact of magnetic impulse stimulation can be carried out both directly through the skin and through clothes, plaster dressings, longs. The procedures are painless and do not irritate the sensitive postoperative area, which is especially important in pediatric practice.

This method of treatment can be used in children who have been operated on for scoliosis, since the metal, namely the titanium structure is non-magnetic, does not heat up during the procedure and the child does not experience unpleasant sensations.

Exposure to a high-frequency pulsed magnetic field with an intensity of 800-900 mT is optimal for use on the thoracic, thoracolumbar spine, for affecting the projection area of the trapezius, latissimus longus, back muscles in children operated on for scoliosis of the 3-4 degree. This frequency is most preferable, since it does not cause discomfort, has the necessary stimulating effect on the muscular system.

DESCRIPTION OF THE METHOD OF TREATMENT

The patient is laid on the couch. Preliminarily turn on the apparatus AMT 2 - "AGS" for 1 minute in order to prepare it for the procedure. On the patient’s body, 2 N and S inductors with a size of 100 × 35 × 220 each are placed, in which mutually opposite magnetic fields are formed. The exposure is carried out by a high-frequency pulsed magnetic field with an intensity of 800-900 mT, intervals between pulses from 120 to 180 ms, 4 pulses in a parcel, lasting 9-12 minutes, for a course of 8-10 procedures paravertebrally, first to the right, then to the left of the spine. The inductor S, due to its greater activity, moves along the spine every 2-3 pulses, and the inductor N is fixed by a bag of sand in the lumbar region, i.e. exposure is carried out according to a labile technique. During the procedure, the child feels a rather pronounced, but painless muscle contraction under the electrodes.

EXAMPLES OF IMPLEMENTING THE METHOD

Example No. 1

A girl Daria K., 16 years old, was admitted to the out-patient department of Children's Clinical Hospital No. 19 at the Turist sanatorium with a diagnosis of dysplastic right-sided thoracic C-shaped scoliosis of grade 4, condition after surgical treatment.

An. morbi: Scoliosis was first detected at 11 years old, and therefore was observed by an orthopedist at the place of residence, several times a year they were in a specialized sanatorium where they received the following treatment methods: exercise therapy, back massage, abdominal massage, electrical stimulation of the back muscles. However, conservative methods of treatment did not bring tangible results, scoliosis progressed. In November 2006, the child was consulted at the Consultative and Diagnostic Center of the Children's City Clinical Hospital (CDC DGKB) No. 13 named after NF Filatova and sent to hospitalization in the 2nd surgical department to address the issue of surgical intervention.

An. vitae: A girl was born from 1 pregnancy, 1 birth per term. Early psychomotor development without features, vaccinated by age. From the transferred diseases notes: acute respiratory infections, chicken pox. Heredity: parents have osteochondrosis of the spine, flat feet.

Status presents communes: Transferred to 28 days after surgery for reconstructive treatment. Upon receipt, the rib hump is absent, there is a deviation of the body to the left by 2 cm. Postoperative scar along the spine without signs of inflammation. General condition and well-being are satisfactory. The skin and visible mucous membranes are pale, clean. Nasal breathing is not difficult, the lymph nodes are not enlarged. In the lungs, vesicular breathing, no wheezing, RR 21, heart sounds are clear, rhythmic. HELL = 110/75 mmHg, pulse 87 in 1 min. The abdomen is of the usual form, with palpation soft, painless, the liver is not enlarged. The kidney area without visible changes. Physiological administration is not disturbed.

Orthopedic status: Standing height 164.5 cm (+5.5 after surgery), sitting 87.3 cm, weight 52 kg. On examination, slight asymmetry of the shoulders, shoulder blades, and triangles of the waist remains. The forward and lateral inclinations are limited, there is no costal hump, palpation of the postoperative suture is painless, the postoperative scar without signs of inflammation.

On the roentgenogram from 11.29.06 - the design position is satisfactory. The main angle of curvature is 10 ° standing, the torsion Th V is 0 °, according to the CT data, the torsion is 2 °, LIII - 0 °. Anti-warp 0 °. Correction of the main angle of curvature of 83.4%, anti-curvature of 100%.

EMG after surgery: There is a decrease in the amplitude of m response with m. trapez. on the right and m. Deltoid, compared with data before surgery.

ECG - Sinus rhythm. Signs of incomplete blockade of the right bundle branch block. Heart rate up to 125 per minute, impaired myocardial repolarization.

Echo KG - EchoKg signs of heart disease were not detected.

Echo-ES dated December 5, 2006 - no m-echo bias was detected. The width of the 3rd ventricle is 4.5 mm. The ripple amplitude is 59%.

FVD - moderate generalized disorders of bonchial patency with suspected restriction. VC is significantly reduced.

Peak expiratory flow rates did not meet age standards and amounted to 280 l / min.

In the department, the girl received: Table 15, orthopedic regimen - spinal discharge mode, exercise therapy in the group of postoperative scoliosis 2 times a day, back, abdominal muscle massage, intercostal 2 times a day, back muscle magnetostimulation, drug therapy (ascorutin, folic acid, fenulis , calcide).

Magnetostimulation of the back muscles was carried out from the apparatus AMT 2 - "AGS". On the patient’s body, 2 N and S inductors with a size of 100 × 35 × 220 mm each are placed, in which mutually opposite magnetic fields are formed. The exposure is carried out paravertebrally, first to the right, then to the left of the spine. The inductor S, due to its greater activity, moves along the spine every 2-3 pulses, and the inductor N is fixed by a bag of sand in the lumbar region, i.e. exposure is carried out according to a labile technique. The intensity of 800-900 mT, with an interval of 120-180 ms, 4 pulses in the sending to the sensation of a pronounced painless muscle contraction under the electrodes. The exposure time is 9 minutes on each side, per course of 10 daily procedures.

The tolerability of the procedures is satisfactory, no complaints. After the course of treatment, re-performed:

EMG: by m. Trapezius noted an increase in the amplitude of the M-response from 3.54 to 7.07 on the right and 5.28 to 6.07 on the left. By m. deltoideus the amplitude of the M-response with asymmetry increased from 4.62 to 5.65 ms on the right and 1.67 to 3.21 ms on the left.

Ecg, Echo Kg, Echo-Es - in the dynamics without significant changes.

FVD - generalized violations of bronchial patency, a slight increase in VC.

The peak expiratory flow rate in the dynamics after treatment improved and amounted to 320 l / min, which corresponds to age norms.

Example No. 2

Boy Maxim K., 16 years old, was admitted to the out-patient department of Children's Clinical Hospital No. 19 with a diagnosis of dysplastic right-sided thoracolumbar scoliosis of the 4th degree, condition after surgical treatment.

An. morbi: Scoliosis was first detected at age 12, and therefore was observed by an orthopedist at the place of residence, was treated several times a year in a specialized sanatorium, where he received: exercise therapy, massage of the back muscles, abdomen, electrical stimulation of the back muscles. However, conservative methods of treatment did not bring tangible results, scoliosis progressed. In March 2007, the child was consulted at the Children's Clinical Children's Clinical Hospital №13 named after NF Filatova and sent to hospitalization in the 2nd surgical department to address the issue of surgical intervention.

An. vitae: The boy was born from 1 pregnancy, 1 birth per term. Early psychomotor development without features, vaccinated by age. From the transferred diseases notes: frequent SARS. Heredity is not burdened.

Status presents communes: Transferred to the tourist department of the Turist sanatorium on the 26th day after the operation for rehabilitation treatment. At admission: general condition and well-being are satisfactory. The skin and visible mucous membranes are pale, clean. Nasal breathing is not difficult, the lymph nodes are not enlarged. In the lungs, vesicular breathing, no wheezing, BH - 19 per min. Heart sounds are clear, rhythmic, blood pressure = 105/70 mm Hg, pulse 85 in 1 min. The abdomen is of the usual form, with palpation soft, painless, the liver is not enlarged. The kidney area without visible changes. Physiological administration is not disturbed.

Orthopedic status: Standing height 178 (+6.5 after surgery), sitting 97 cm, weight 67 kg. On examination, slight asymmetry of the shoulders, shoulder blades, and triangles of the waist remains. Spinal mobility is limited, the rib hump is absent, postoperative suture palpation is painless, scar without signs of inflammation.

On the roentgenogram from 11.29.06 - the design position is satisfactory. The main angle of curvature is 10 ° while standing, the torsion of Th X is 0 °, according to CT data, torsion is 1 °, LII is 34 °. 8 ° anti-warp. Correction of the main angle of curvature 86%, anti-curvature 87%.

EMG after surgery: In the abduction with m. trapez. the amplitude of the M-response is symmetric, sufficient. At assignment with m. Deltoid on the left the amplitude of the M-response is reduced.

ECG - Sinus rhythm. Signs of incomplete blockade of the right bundle branch block. Heart rate up to 115 per minute, impaired myocardial repolarization.

Echocardiography - Echocardiography did not reveal signs of heart disease.

Echo-ES dated December 5, 2006 - no m-echo bias was detected. The width of the 3rd ventricle is 4.5 mm. The ripple amplitude is 54%.

FVD - moderate generalized disorders of bronchial obstruction with suspected restriction. VC is significantly reduced.

According to peak flowmetry, peak expiratory flow rates were 250 l / min.

In the department he received: Table 15, an orthopedic regimen for unloading the spine, exercise therapy in the group of postoperative scoliosis, massage of the muscles of the back, abdomen, intercostal 2 times a day, magnetostimulation of the muscles of the back, drug therapy (ascorutin, folic acid, fenyuls).

The boy received magnetostimulation of the back muscles from the AMT 2 apparatus - “AGS”. On the patient’s body, 2 N and S inductors with a size of 100 × 35 × 220 each are placed, in which mutually opposite magnetic fields are formed. The exposure is carried out paravertebrally, first to the right, then to the left of the spine. The inductor S, due to its greater activity, moves along the spine every 2-3 pulses, and the inductor N is fixed by a bag of sand in the lumbar region, i.e. exposure is carried out according to a labile technique. The intensity of 800-900 mT, with an interval of 120-180 ms, 4 pulses in the package. During the procedure, the child feels a pronounced, painless muscle contraction under the electrodes. The exposure time is 9 minutes on each side, per course of 10 daily procedures. Tolerance of the procedures is satisfactory, no complaints.

After the course of treatment were repeated:

EMG: By m. Trapezius noted an increase in the amplitude of the M response from 7.60 to 8.92 ms on the left with an asymmetry of D <S. According to m.deltoideus, the amplitude of the M-response increased on the left from 1.70 to 4.56 ms, on the right it slightly decreased to 3.09 ms.

Ecg, Echo Kg, Echo-Es FVD - in dynamics without significant changes.

The dynamics of peak expiratory flow rate improved and amounted to 380 l / min, which corresponds to age norms.

The proposed method of treatment was applied in 60 children operated on for scoliosis of the 3-4 degree, aged 10 to 16 years. The work was carried out on the basis of the out-patient department of Children's Hospital No. 19 named after T. S. Zatsepin, the sanatorium “Tourist” for children with diseases of the musculoskeletal system. Among the children examined, children with right-sided scoliosis in the thoracic and thoracolumbar grades 3 and 4 predominated, the smaller group consisted of children with left-sided localization of scoliosis. Among the concomitant diseases in the anamnesis were identified: chronic gastritis, chronic pyelonephritis, chronic cholecystitis in remission. The proposed method of treatment was included in the complex of traditional treatment, including the mode of unloading the spine, a set of physical therapy classes, massage of the muscles of the back, abdomen, chest. All children tolerated treatment with the proposed method, no adverse reactions were noted. By the end of the course of treatment, all children felt better, there was a decrease in general fatigue, and children recovered faster in the postoperative period. Patients showed a positive dynamics of clinical symptoms: an increase in endurance indicators of back muscles, the disappearance of pain, an improvement in the functional state of the cardiorespiratory system.

Claims (1)

A method for treating children operated on for scoliosis of the 3-4 degree by exposure to a high-frequency pulsed magnetic field, characterized in that the child is exposed to a pulsed magnetic field with an intensity of 800-900 mT, intervals between pulses from 120 to 180 ms, 4 pulses in a parcel , lasting 9-12 minutes on each side, for a course of 8-10 procedures daily.