RU2411968C1 - Method of treating patients with gonarthrosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine and is intended for treatment of patients with degenerative diseases of joints. Native naphthalan, preliminarily heated in water bath to temperature 37-38°C, is applied evenly with 8-10 cm covering of surrounding tissues above and under affected joint. Joint is wrapped with disposable water-proof napkin. Cylindrical inductors from apparatus "Polus-2" are applied on the same region. Without time interval performed is impact by pulsing magnetic field with frequency 50 Hz, induction 50-75 mT, impact duration is 15-20 minutes on each joint. Procedures are carried out daily, 10-12 procedures per a course.

EFFECT: method allows to improve clinic course of gonarthrosis, increase complex therapy efficiency.

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Description

The invention relates to medicine, in particular to rheumatology and rehabilitation medicine, namely the treatment of patients with degenerative diseases of the joints and can be used in medical institutions.

Osteoarthrosis (OA) - the most common joint disease - is one of the main causes of temporary disability and disability and a more important factor in limiting the level of physical activity than heart disease, hypertension and diabetes. In the structure of the incidence of OA, a significant place is occupied by patients with gonarthrosis (GA) - a lesion of the knee joint. The leading pathogenetic factor in gonarthrosis is the degeneration and destruction of articular cartilage, which develops as a result of the mismatch between the mechanical load on the articular surface and its ability to resist this load. In recent years, the concept of OA as a degenerative cartilage lesion has been supplemented with new data on the role of chronic inflammation in its formation and progression.

The active introduction of drugs with chondroprotective properties that can stop structural changes in cartilage and selective non-steroidal drugs with anti-inflammatory and analgesic properties significantly improved the prognosis of patients with GA [Alekseeva L.I. - Rheumatology. National leadership. - M., 2008. - P.573-589]. However, the search for new effective and safe treatments remains relevant.

Known methods for treating patients with gonarthrosis with physical factors, for example, using sinusoidal modulated currents, infrared laser radiation, a constant and pulsed magnetic field, ultrasound therapy, hydrogen sulfide baths, cryotherapy [Textbook on rehabilitation medicine, ed. Razumova A.N., Moscow, 2009, p. 421-444].

However, none of these methods fully satisfies the principles of treating gonarthrosis: reducing pain and secondary inflammatory phenomena, improving the functional ability of joints, slowing the progression of the degenerative process, improving the quality of life of patients, and reducing the risk of exacerbations.

The closest in technical essence to the proposed method for the treatment of patients with gonarthrosis is a method of magnetotherapy. The essence of low-frequency magnetotherapy is the formation of induced electric currents in tissues (according to the law of Faraday electromagnetic induction), the density of which is determined by the frequency and amplitude of the magnetic field. These currents are induced in tissues when exposed to a low-frequency magnetic field with a frequency of 50 Hz and magnetic induction of 50 mT by means of cylindrical inductors lasting 15-20 minutes [Practical physiotherapy. Ed. Ushakova A.A. - M .: Medical Information Agency, 2009, p.133]. The disadvantages of the prototype are that magnetotherapy has a significant effect on blood flow velocity, the amount of circulating blood and venous outflow (decongestant effect), having a trophic and definite analgesic effect, does not change the functional properties of the thermomechanically sensitive structures of tendons and ligaments, and does not reduce muscle spasm and weaken contractures, does not significantly affect the activity of the inflammatory process in the joints and does not have sufficient analgesic ence.

The technical result of the proposed method for the treatment of patients with gonarthrosis is to reduce the activity of the inflammatory process, relieve pain, restore functional insufficiency of the musculoskeletal system, increase daily activity, increase the effectiveness of treatment.

The specified technical result is achieved by the fact that after uniform application of native naphthalan to the affected joint area, preheated in a water bath to 36-37 ° C, the joint is wrapped with a disposable waterproof towel, cylindrical inductors from the Polyus-2 apparatus are applied to the same area, and without a time interval, they are exposed to a pulsating magnetic field with a frequency of 50 Hz, induction of 50-75 mT, exposure duration of 15-20 minutes for each joint, the procedures are carried out daily, for a course of 10-12 processes ur.

According to research, this exposure mode is optimal for the combined effects of a magnetic field and naphthalan applications. The improvement in blood supply and microcirculation caused by magnetotherapy in the subchondral bone, synovial membrane and periarticular tissues is complemented by the anti-inflammatory and analgesic effects of naphthalan, which enhances and potentiates their therapeutic effects.

Description of the treatment method:

The method is as follows: in the supine position with the help of a brush, naphthalanum is preheated in a water bath to a temperature of 37-38 ° C. After that, the joint is wrapped with a disposable waterproof towel, cylindrical inductors from the Pole-2 apparatus are applied (reg. No. 29/06020302 / 3836-02 of June 28, 2002, VNIIMP-VITA plant, Moscow) and exposure is performed pulsating magnetic field with a frequency of 50 Hz, an intensity of 50-75 mT. The duration of magnetotherapy is 15-20 minutes for each joint. The procedures are carried out daily, 10-12 procedures are prescribed for the course.

An example implementation of the method. Patient A., 55 years old, teacher, was admitted to the hospital with a diagnosis of osteoarthritis of the knee joints, bilateral gonarthrosis, stage II-III, chronic gastritis. Upon receipt of a complaint of mechanical pain in the knee joints, limitation of movement, a decrease in daily activity. The pain intensified after physical exertion, wearing heaviness, when climbing, and especially when descending stairs. In addition, there were starting pains in the knee joints that appear after a long sitting when trying to get up from a chair or chair, limiting flexion by 15-20 °. She considers herself a patient for more than 8 years, when for the first time short-term pains appeared in the right knee joint after a long standing in front of a blackboard in the classroom, a long walk that took place after a short rest. Subsequently, pain began to appear with greater frequency and intensity and stopped only with the help of analgesics. 2 years after the onset of the disease, pain began to occur and progress in the left knee joint. With a dynamic x-ray examination of the knee joints over the past three years, an increase in bone changes has been noted. About 3 months ago, morning stiffness appeared in the knee joints lasting up to 20 minutes. To stop the pain syndrome and normalize daily physical activity, he takes non-steroidal anti-inflammatory (NSAIDs) drugs (diclofenac 100-150 mg / day) continuously, in short courses. In connection with the appearance of signs of NSAID gastropathy in recent months, he uses the drug meloxicam, in a daily dose of 15 mg, which is better tolerated. Upon examination, the condition is satisfactory. The skin is of normal color. Vesicular breathing. No wheezing. BH 19 in minutes Heart sounds of medium strength, the ratio is correct. HELL 130/90 mm Hg Pulse 78 beats. in minutes, rhythmic. On palpation, the liver is not enlarged, the abdomen is soft, slightly painful in the epigastric region. Pasternatsky’s symptom is negative from 2 sides. Weight 87 kg with a height of 170 cm.

Status lokalis: Symmetrical deformity and configuration of both knee joints is noted. Palpation of pain in the knee joints along the joint gap, especially on the medial surface, is most pronounced on the right side, as well as in the bursa anserine area on both sides. Hypotrophy of the quadriceps femoris muscle, slight crepitus in the knee joints, flexion contracture (muscle-tendon) on the right 20 °, on the left 15 °.

When analyzing the results of clinical and biochemical studies of blood and urine, pathological deviations were not detected. When radiography of the knee joints was observed narrowing of the joint gap, subchondral osteosclerosis, osteophytosis. An objective physical examination of clinical indicators showed that the severity of pain on a visual analogue scale (VAS) was 6 points, the number of affected joints was 2, the articular index was 14 points, the Womac index was 127 points, the Lequesne index was 20 points. Morning stiffness in the knee joints lasted up to 20 minutes. The values of such indicators as malaise and assessment of the general condition of the patient, measured by YOUR, were 6 and 5 points, respectively. At the time of admission, over the past 7 days I took 15 mg of meloxicam daily (Movalis).

The effect of naphthalanotherapy in combination with magnetotherapy of the Pole-2 apparatus on the knee joints was carried out. The impact was carried out by applying the area of the knee joints with the capture of surrounding tissue 8 cm above and below the joint. Consistently, without a time interval, magnetotherapy was carried out on the area of the knee joints through cylindrical inductors in a pulsating mode with a frequency of 50 Hz, induction of 50-75 mT (3-4 steps), exposure duration of 15 min to each joint. The course of treatment was 10 procedures.

After treatment with the claimed method, clinical improvement was observed, which was expressed in a significant decrease in pain intensity (by YOUR) by 43% and articular index by 31%. A significant decrease in the Womas index (by 39%) and the Lequesne index (by 35%) indicated a decrease in the severity of gonarthrosis, an increase in the functional activity of patients and restoration of locomotor function. Upon completion of the course of treatment, it was possible to reduce the dose of the drug (meloxicam) by 50%.

Example 2. Patient B., 59 years old, a pensioner. Received with a diagnosis of:

Bilateral gonarthrosis, X-ray stage III, common osteochondrosis. Upon admission, she presented the main complaints for pain in the knee joints, lumbar spine, morning stiffness for 30 minutes, limitation of range of motion in the knee joints and spine, crunch. Notes intensification of pain during physical exertion and their subsidence at rest. Considers herself a patient for more than 15 years. The cause of the disease was probably overweight, hereditary factors. Despite the ongoing pharmacotherapy (analgesics, non-steroidal anti-inflammatory drugs, muscle relaxants), the disease progressed over the past 5 years, the appearance of pain, and movement restrictions in the cervical and lumbar spine. For the relief of pain, it takes up to 4 g per day of acetaminophen, with insufficient analgesic effects - up to 400 mg of celebrex. For more than three years, he has been systematically receiving chondroprotectors (structure, alflutop). An X-ray examination at the time of admission to the clinic revealed a moderate narrowing of the joint gap in the knee joints, multiple osteophytes.

Upon examination, the condition is satisfactory. The skin and mucous membranes are normal in color. With auscultation in the lungs vesicular breathing, no wheezing. BH 18 in minutes Heart sounds are muffled, the ratio is correct. HELL 140/100 mm Hg Rhythmic pulse 84 beats. in minutes The liver is not enlarged, the abdomen is soft, painless on palpation. Pasternatsky’s symptom is negative. Weight 95 kg, with a height of 173 cm.

Status lokalis: On examination, varus deformation of the knee joints, palpation of the knee joints along the joint gap, flexion contracture up to 30 ° are determined. Palpation of paravertebral points along the spine is painful in the cervical and lumbar regions. In a clinical examination, the severity of pain on a visual analogue scale was 8 points, the articular index was 16 points, the Womac index was 138 points, and the Lequesne index was 22 points. Morning stiffness in the affected joints lasted an average of up to 30 minutes. The values of such indicators as malaise and assessment of the general condition of the patient, measured by YOUR, were 8 and 6 points, respectively. When analyzing laboratory test data, pathological abnormalities were not detected. When radiography of the affected joints was observed moderate narrowing of the joint space, multiple osteophytes, which corresponded to stage III ostearthrosis according to Kellgren and Lawrence. Upon admission to the clinic, she took drug therapy (celebrex 200 mg), the dose of which remained unchanged during the treatment period.

Naphthalanotherapy was combined with low-frequency magnetotherapy from the Pole-2 apparatus on the knee joints. The impact was carried out by applying the area of the knee joints with the capture of surrounding tissue 10 cm above and below the joint. Consistently, without a time interval, magnetotherapy was carried out on the area of the knee joints through cylindrical inductors in a pulsating mode with a frequency of 50 Hz, induction of 50-75 mT (3-4 steps), the exposure duration was 20 min for each joint. The course of treatment was 10 procedures.

The course of treatment caused clinical improvement, which was expressed in a significant decrease in pain intensity (by YOUR) by 35% and articular index by 38%. There was a significant decrease in the Womaс index (by 41%) and the Lequesne index (by 37%).

Thus, after treatment with the claimed method, there was a normalization of functional disorders of the locomotor apparatus, an increase in daily physical activity, a decrease in the intensity of joint pain, a regression of local signs of an inflammatory reaction.

The proposed method for the treatment of gonarthrosis was tested in the arthrology department of the Russian Center for Reconstructive Medicine and Balneology of the Russian Health on 50 patients with arthrosis of the knee joints, among whom were women (88%). The average age of the subjects was 55.3 ± 2.4 years. Among patients with gonarthrosis in 48% of cases, a unilateral lesion was recorded, in the rest - bilateral.

Evaluation of the clinical status of patients was carried out on the basis of patient complaints, medical history, and direct examination of the joints. To evaluate the effectiveness of treatment before and after the course of treatment, the following clinical indicators were evaluated: pain according to a 100 mm visual analogue scale (VAS), the duration of morning stiffness in the joints — estimated in minutes, the patient’s overall assessment of his condition according to VAS; malaise assessed by YOUR; Lequesne index, which includes an assessment of pain at rest and when walking, the maximum distance traveled and daily activity; Womac index, designed for self-assessment (by YOUR) of the patient the severity of pain (at rest and when walking), stiffness (duration and severity) and functional impairment in everyday activities.

The main complaints were presented with mechanical pain in the affected joints, morning stiffness lasting no more than 30 minutes, restriction of active and passive movements, swelling of the joint due to a small effusion. An objective study determined palpation of sore joints, their configuration and deformation, reduction of goniometric indicators. In 48.3% of patients, extensor contractures were observed. In 18.3% of cases, synovitis of the knee joints was recorded.

After treatment with the proposed method in patients with gonarthrosis, there was a decrease in the period of morning stiffness in 22 out of 25 cases, a decrease in pain intensity in 44 out of 50 cases, an increase in the range of motion in the joints in 40 out of 45 cases, elimination of contractures in 27 out of 31 patients. Repeated results tests revealed significant positive dynamics of the Womac index and Lequesne index, indicating a decrease in the severity of osteoarthritis and an increase in the functional activity of the musculoskeletal system.

Based on the foregoing, it should be noted that the proposed method is a clinically highly effective, reasonable and safe method of treating patients with gonarthrosis, as it helps to improve the clinical course of the disease, namely, relieves pain, reduces the period of morning stiffness, eliminates contractures, restores functional deficiency of support motor apparatus, increasing the daily activity of patients, reducing the severity of the pathological reaction. The claimed method favorably affects the general state of health, improves the prognosis of the disease; the method is simple to perform, can be carried out in a hospital, clinic, sanatorium, rehabilitation center.

Claims (1)

A method of treating patients with gonarthrosis by magnetotherapy on the background of drug therapy, characterized in that after uniform application of native naphthalan to the affected joint area, preheated in a water bath to a temperature of 37-38 ° C, the joint is wrapped with a disposable waterproof towel, cylindrical are applied to the same area inductors from the apparatus "Pole-2" and without a time interval effect a pulsating magnetic field with a frequency of 50 Hz, induction of 50-75 mT, exposure duration of 15-20 min for each joint, procedures are carried out daily, for a course of 10-12 procedures.