RU2370218C1 - Method of predicting efficiency of viscosapplimentary therapy in case of knee joint osteoarthrosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology and orthopaedics. In order to predict efficiency of viscosupplementary therapy in case of knee joint osteoarthrosis, synovial knee joint fluid is taken by its puncture. Facies is obtained for synovial fluid testing. Photometry of synovial fluid is carried out, brightness of peripheral and central facies zones is determined. Ratio of brightness of peripheral zone to central zone is calculated. If value of obtained ratio is less than 1.2 highly efficient carrying out of viscosupplementary therapy is predicted. If value is within the limit from 1.2 to 1.8 moderately efficient performing of viscosupplementary therapy is predicted. If obtained ratio value is higher than 1.8 effect of viscosupplementary therapy is questionable.

EFFECT: method increases accuracy of predicting efficiency of carrying out viscosupplementary therapy, allows to reduce labour intensiveness due to replacement of qualitative estimation of facies character during microscopy with digital photos and automatic determination of ratio of brightness of two zones on quantised image.

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Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used to predict the effectiveness of viscometer therapy for osteoarthritis of the knee joint.

With osteoarthritis of the knee joint, its long-existing pathology leads to significant changes in the synovial environment, as a result of which the synovial fluid in its composition and properties is not able to provide movement in the joint, even taking into account their limitation by the underlying disease. This condition can be overcome by the introduction of synthetic or semisynthetic preparations with the properties of synovial fluid - synovial substitution media (Synvisc, Viskornil, Ostenil, etc.). These new and expensive drugs, however, are effective only in 65-70% of patients. Currently, the strategy for determining the indications for their use is dominated by an approach based on the determination of the stage of osteoarthritis and the duration of the disease. As a result, the evidence is based on the results of determining the functional state of the joint and the quality of life of the patient, which have no prognostic value. A direct determination of the composition and properties of synovial fluid in these approaches is not adequately reflected.

A known method for determining the prognosis of therapeutic tactics for osteoarthritis of the knee joint (see Shabalin V.N., Shatokhina S.N. Morphology of human biological fluids, Moscow, Chrysostom, 2001, p.259), which consists in the removal of synovial fluid of the knee joint by puncture getting facies for synovial fluid research.

However, in the known method, when analyzing synovial fluid, it is possible to obtain only normal or pathological patterns of fluid crystals, which allows one to judge only about the chemical composition of the biological fluid, as well as their integral surface-active, sorption and osmotic properties. Those. despite the diagnostic value of a qualitative assessment of the morphological picture of the synovial fluid facies in the known method, there are no criteria to evaluate and predict the effectiveness of the treatment of osteoarthritis of the knee joint.

The present invention solves the problem of developing a new method for predicting the effectiveness of the treatment of osteoarthritis of the knee joint, namely the conduct of viscometer therapy. The technical result obtained in this case consists in increasing the accuracy of predicting the effectiveness of viscometer therapy and, accordingly, reducing the number of uncertain and false-negative forecasts. In addition, the proposed method allows to reduce the complexity by replacing a qualitative assessment of the nature of the facies under microscopy (official time for microscopy of one micropreparation - 5 min) with a digital photo and automatic determination of the ratio of the brightness of two zones in a digitized image - 1 min. It does not require a qualified specialist with a higher education, just a laboratory technologist.

The specified technical result is achieved by the fact that in the method for predicting the effectiveness of viscometric therapy for osteoarthritis of the knee, consisting in the removal of synovial fluid of the knee by puncture, obtaining the facies for the study of synovial fluid, photometry of the synovial fluid facies is carried out, the brightness of the peripheral and central zones of the facies is determined, calculate the ratio of the brightness of the peripheral zone to the Central zone and when the value of the obtained ratio is less than 1.2 predict They have highly effective viscometric therapy, with a value in the range from 1.2 to 1.8 - moderately effective, and with a ratio of more than 1.8, the effect of viscometric therapy is doubtful.

A method for predicting the effectiveness of viscometer therapy for osteoarthritis of the knee joint is as follows.

In patients with stages I, II and III of osteoarthritis, prior to performing visco-complimentary therapy, a knee joint is punctured to remove synovial fluid. To study the synovial fluid of the knee joint, its drop (0.05 ml) is placed on a defatted glass slide and left to dry at room temperature for 20 minutes, preventing dusting of the surface (for example, in a flat plastic case). Get the facies. Photometry of the synovial fluid facies is carried out by digitally photographing the facies under a microscope at 10-20x magnification and save the file in jpg format, while highlighting the facies area at least 20% of the total facies area. The brightness of the peripheral and central zones of the facies in the RGB system is determined using one of the available computer programs. The ratio of the brightnesses of the peripheral zone to the central zone is calculated and a value characterizing the general heterogeneity of facies formation and indirectly the physicochemical properties of the synovial fluid are obtained. Based on the value of the obtained brightness ratio, the effectiveness of visco-complimentary therapy is predicted. If the ratio of the brightness of the peripheral zone to the central zone is less than 1.2, highly effective viscometric therapy is predicted. When the value of the ratio of brightness in the range from 1.2 to 1.8 - predict a moderately effective result of viscometer therapy. With a brightness ratio of more than 1.8, the synovial fluid has the initially adequate properties of intraarticular fluid lubrication, the effect of viscometric therapy is doubtful. This may serve as the basis for refusing to bring in visco-complimentary therapy.

Clinical example

Patient K.M.K., born on 29.04.56, medical history No. 2140/583, diagnosis: deforming osteoarthritis of the right knee joint, II degree. Before conducting a course of visco-complimentary therapy, a right knee joint was punctured, and about 5 ml of synovial fluid was withdrawn. A drop of synovial fluid (0.05 ml) was placed on a fat-free glass slide, dried at room temperature for 20 minutes under conditions that prevent dusting of the surface (in a flat plastic case). Got a facies. Photometry of the facies of the synovial fluid was carried out by digitally photographing the facies under a microscope at 10x magnification, we saved the file in jpg format, while highlighting the facies area at least 20% of the total facies area. The brightness of the peripheral and central zone of the facies in the RGB system was determined using the Radiana computer program. In the peripheral zone of the facies, the brightness was 0.262, in the central zone of the facies - 0.238. The ratio of the brightness of the peripheral zone to the central zone was calculated and a value (0.262 / 0.238) of 1.1 was obtained. According to the value of the obtained brightness ratio 1.1 <1.2, the high efficiency of visco-complimentary therapy was predicted, which later, after a course of visco-complimentary therapy, was confirmed by the assessment of the clinical effect of treatment by the patient and the doctor.

Claims (1)

A method for predicting the effectiveness of viscometric therapy for osteoarthritis of the knee, which consists in removing the synovial fluid of the knee by puncture, obtaining facies for the study of synovial fluid, characterized in that photometry of the facies of the synovial fluid is carried out, the brightness of the peripheral and central zones of the facies is determined, and the ratio of the brightness of the peripheral zones to the central zone and when the value of the obtained ratio is less than 1.2, highly efficient skosapplimentarnoy therapy at a value in the range from 1.2 to 1.8 - moderately effective, and if the ratio value obtained from 1,8 effect of viskosapplimentarnoy therapy is questionable.