RU2419465C1 - Method of treating patients with deforming arthrosis - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention refers to medicine, namely - to orthopaedics and physiotherapy. The method involves extremely high frequency (EHF) electromagnetic irradiation of a joint region. The EHF electromagnetic irradiation is executed at carried out at frequency range of nitrogen oxide radiation and absorption 150.176-150.664 GHz. Radiation power density is 0.2 mWt/cm2. The exposure lasts for 5 minutes and covers 3 skin areas located in a projection of a medial, middle and lateral region of a joint space. The exposure is daily for 10 days. ^ EFFECT: method provides correction of disturbed microcirculation of bone and cartilaginous tissues and microangioarchitectonics recovery. ^ 1 ex, 1 tbl, 3 dwg

Description

The invention relates to medicine, in particular to orthopedics and physiotherapy, and can be used to treat patients with deforming osteoarthritis.

One of the key pathogenetic links that determine the severity of catabolic processes in bone and cartilage in the early stages of degenerative-dystrophic diseases is a violation of bone microcirculation. The development and implementation of effective methods for correcting disorders of bone microcirculation, as the basis of pathogenetic therapy of degenerative-dystrophic pathology, is an urgent task of modern orthopedics.

One of the traditional methods of therapeutic effect on the damaged tissue site is the additional use of physical methods that contribute to the normalization of their regeneration processes and reduce complications (inflammatory and dystrophic processes, osteomyelitis, false joints, etc.). The physical methods of exposure are based on an attempt to control the recovery processes.

The results of numerous clinical and experimental studies have proved that EHF radiation is one of the most effective factors used by modern physiotherapy: normalizes the rheological properties of blood, is an antioxidant of a physical nature [Zubkova S.M. Comparative analysis of the biological effects of microwaves and laser radiation. // Issues. health resort. - 1996. - No. 6. - S.31-34; Kovalev A.A. Bioelectric equivalents of the cortical mechanisms of human body sanogenesis under normal, pathological conditions and under the influence of non-thermal effects of electromagnetic radiation of the EHF range. // Millimeter waves in biology and medicine. - 1998. - No. 2. - S.16-27; Lebedeva N.N., Kotrovskaya T.I. Experimental and clinical research in the field of biological effects of millimeter waves (review, part 1). // Millimeter waves in biology and medicine. - 1999. - No. 3. - P.3-13.], Causes the normalization of the tone of the brain and peripheral vessels, improves microcirculation in damaged tissues [Gaponyuk P.Ya., Stolbikov A.E., Sherkovina T.Yu., Zhukovsky V.D. The influence of low-intensity electromagnetic radiation of the millimeter range on the bioelectric activity of peripheral, central nervous structures and systemic hemodynamics of patients with hypertension. // Q. health resort. - 1988. - No. 3. - S.14-18; Zhukov B.N., Lysov N.A. The effect of MM waves on microcirculation. // Millimeter waves in medicine and biology: Sat. doc. 11 Ross. symposium with mzhd participation. - M., 1997. - S.120-121.]. This led to the widespread use of EHF-therapy in medical, including orthopedic and traumatological practice (Polyakova A.G., Buylova T.V., Aleinik D.Ya., Kolesov S.N., Kornaukhov A.V., Priluchny M.A. ., Kapustina NB A comprehensive study of EHF exposure in the experiment and in the rehabilitation of patients with degenerative-dystrophic pathology of large joints. // Millimeter waves in biology and medicine. 1999. No. 1 (13). S.22-27.) .

In medicine, electromagnetic radiation of various wavelengths has long been used, but only relatively recently has begun the use of electromagnetic radiation (EMP) of the millimeter range, which include waves from 1 to 10 mm in length. Frequencies from 30 to 300 GHz (EHF range) correspond to them, and the medical use of millimeter waves is called EHF or millimeter therapy. The use of such radiation was based on the assumption that the human body, as a frequency-selective system, will select an individual frequency from the acting noise EHF signal corresponding to this organism and this pathology. The primary target of millimeter wave effects in the “physiological” concept refers to water molecules, in fact, those that are associated with the protein structures of skin collagen. The change due to this effect of the electret state of collagen and its piezoelectric properties causes the excitation of sensitive nerve fibers in the skin receptors - Ruffini bodies. Then follows the excitation of the preganglionic sympathetic neurons of the lateral horns of the spinal cord, the excitation of the MIF neurons located in the vegetative ganglia, which secrete adrenaline, norepinephrine, etc. into the synaptic clefts and the vascular bed.

A known method of using electromagnetic therapy of EHF for the treatment of patients with diseases of the musculoskeletal system, which uses radiation of the millimeter range of low intensity, created by apparatus "Yav-1", at a frequency of 53.534 GHz (5.6 mm) or 42.194 GHz (7.1 mm). Irradiation is carried out at a flux density of incident power of 10 mW / cm ² , in the frequency modulation mode f = 50 Hz, the modulation bandwidth is 100 MHz. The impact is on the area of the pathological process: with arthrosis-arthritis on the corresponding joints. The duration of the session is 30 minutes 1-2 times a day, the course of treatment is 10-20 sessions (I.E. Detlav, I.Ya. Naudinya, A.V. Tarauska EHF electromagnetic radiation in diseases of the musculoskeletal system. In the book. Issues of use low-power electromagnetic radiation of extremely high frequencies (millimeter waves) in medicine. / EHF-therapy, vol. 3, collection of teaching materials for practicing physicians. - Izhevsk: JSC Scientific Research Center "IKAR", 1992. 172 p.).

The disadvantage of this method is the reflex principle of influence on the central and peripheral mechanisms of microcirculation regulation, which does not always allow counting on the effectiveness of this type of exposure in relation to areas of bone tissue with impaired microcirculation due to a degenerative-dystrophic process. The penetration depth into the tissues of this EMR range does not exceed 3-5 mm. The use of this method of EHF-therapy in clinical practice requires additional laboratory monitoring (calculation of the Garkavi-Kvakina-Ukolova indicator by the ratio of lymphocytes to segmented neutrophils in the leukocyte formula) and consideration of adaptive reactions, considered as criteria for individual selection of the necessary modes of EHF-therapy as applied to a specific to the patient. Moreover, the presence of “stress” reactions in patients requires an increase in the duration of exposure to 60 minutes. The above features create additional organizational and methodological difficulties in practical implementation. In addition, when using this method, it was noted that not all patients with a training or activation reaction had a therapeutic effect.

We have proposed a method for treating deforming arthrosis, including irradiating the affected joint with EHF radiation, characterized in that they are exposed to EHF radiation at a frequency of nitric oxide (150.176-150.664 GHz) with a power density of 0.2 mW / cm ² for 15 minutes daily for 10 days.

The advantage of our proposed method is the use of the resonant effect on the frequency of the molecular spectrum of absorption and radiation of nitric oxide (MSPIOA), which allows activating the metabolic and reflex effects of OA on the rheological and vascular components of microcirculation in bone tissue. At the same time, the mechanism of the impact of EMR MSPIOA is resonant, independent of the nature of the adaptive reactions, and does not require individual selection of the necessary EHF-therapy regimen for a specific patient. In addition, the EMP used in our proposed method has a penetration depth of up to 50 mm in biological tissues, which ensures maximum impact efficiency directly in the pathological focus.

The method is as follows

Irradiation is carried out by a small-sized medical device “KBCH-NO”, developed by the medical and technical association of the EHF (Moscow) in conjunction with the Federal State Unitary Enterprise NPP-Istok (Fryazino) and Central Research Institute of Nuclear Research (Saratov) [O. Betsky. , Krenitsky A.P., Mayborodin A.V. et al., 2006]. The structure of the molecular THG spectrum of EMP at the frequencies of the MSPIOA is formed by this generator in accordance with the methods proposed and implemented in the quasi-optical EHF generator complex for deterministic noise modeling for biophysical studies developed at the Central Research Institute of Nuclear Research [Krenitsky AP, Maiborodin AV, Betsky O.V. et al., 2003].

The surface of the skin is 3 cm ² over the area of the affected joint. In one session, 3 skin areas are irradiated, located in the projection of the medial, middle and lateral areas of the joint space. The irradiator is located at a distance of 1.5 cm above the surface of the skin. The power density incident on the skin is 0.2 mW / cm ² .

The total duration of a single exposure is 15 minutes in the amplitude modulation mode of the signal at a frequency of 150.176-150.664 GHz. Accordingly, irradiation is carried out for 5 minutes on each of the 3 skin sites. The number of radiation sessions per treatment course is 10.

The effectiveness of our proposed method is confirmed by an experimental study and clinical data.

The experiments were carried out on 63 white outbred rats - males weighing 180-220 g. Animals were supplied from the vivarium of the State Educational Institution of Higher Professional Education “Saratov State Medical University of Roszdrav”, where they were kept under standard conditions. To eliminate the influence of seasonal and circadian dependence on the system of homeo- and hemostasis, experiments were carried out in the autumn-winter period in the afternoon. All experimental animals were in the same conditions. The experiments were carried out in a separate laboratory, excluding extraneous irritants, at a constant air temperature of 18-22 ° C, with a standard level of illumination, air humidity of 50-70%. When kept in the laboratory, animals were provided with balanced food and water without restriction.

The choice of rats as an object of study was due to the fact that they are convenient experimental material for mass acute and chronic experiments. These animals have an increased sensitivity to limitation of motor activity (Fedorov I.V., 1980) and to the action of EMR of various ranges (Grabovskaya E.Yu., 1992; Chuyan EN, 1992). To form experimental groups, sexually mature animals of the same age, gender (males), and weight were selected. Such selection made it possible to form homogeneous groups of animals with the same constitutional features, reacting similarly to the action of various stressors.

Microcirculatory disorders were modeled by immobilization stress [Antonov AM, Belikina NV, Georgieva et al., 1964]: acute stress variant — rigid fixation of rats on the back for 3 hours, chronic stress variant — rigid fixation of rats on back for 5 days for 3 hours daily.

Animal experiments were carried out in accordance with the requirements of the Geneva Convention "International Guiding Principles for Biomedical Research Involving Animals" (Geneva, 1990).

The study included 9 series of experiments, each of which was performed on 7 animals. In 1, 2, 3, and 4 series of experiments, simulations of acute immobilization stress in rats were performed. In the first series of experiments, additional external influences were not used. In the remaining three series of experiments, animals were irradiated with electromagnetic waves of the terahertz range against the background of acute immobilization stress.

The duration of a single exposure was 5, 15, and 30 minutes in the amplitude modulation mode of the signal at a frequency of 150.176-150.664 GHz. In the second series, the exposure time was 5 minutes, in the third series - 15 minutes, and in the fourth series - 30 minutes. In 5-8 series of experiments, the animals were in conditions of chronic immobilization stress. Moreover, in the 5th series of external additional influences were not applied. In 6-8 series of experiments, animals were irradiated with electromagnetic waves of the terahertz range against a background of chronic immobilization stress. In the sixth series, the exposure time was 5 minutes, in the seventh series - 15 minutes, and in the eighth series - 30 minutes. The ninth series of the experiment consisted of 7 animals that were not subjected to stressful irritation and no additional external influences (intact control).

Animals at the end of the experiment were decapitated in compliance with the basic requirements for euthanasia set forth in Appendix No. 4 to the "Rules for the work using experimental animals." A series of cytological preparations (blood smears, red bone marrow) were prepared, and CMC, sternum, femurs (bone and cartilage tissue) were taken, followed by their fixation in various solutions for light microscopy.

Under immobilization stress (to a greater extent in chronic and to a lesser extent in acute), the most significant changes occurred in capillaries and scapillaries, where signs of stasis, aggregation and sludge of blood cells were noted. In the venules, adhesion of leukocytes (“marginal standing”) to the laminar surface of vessels with their migration to the perivascular region was noted. An amorphous type sludge was formed in the ICR system (according to the classification of V.V. Kupriyanov, 1969). The parietal zones contained platelet clusters, which indicated the beginning of thrombosis.

All of the above changes led to stasis in the post-capillary-venular part of the system. A reduction of a significant number of capillaries that lost their functional purpose was revealed.

In group 5 animals exposed to chronic stress, the general condition of rats progressively worsened during the experiment. From the point of view of the morphology of ICR, the pathological transformation of ICR was totally determined (in the studied organs). Changes in vascular smooth muscle and endothelial cells increased, accompanied by metachromasia, mosaic hyperchromism, signs of dystrophy of all cellular elements, connective tissue fibers and perivascular structures became pronounced - all this was accompanied by increased deformation of blood vessels and sinuosity. In all objects of study (bone tissue and CMC), perivascular edema, cell infiltration due to increased permeability of the vascular wall increased along the vessels of the exchange and outlet parts of the ICR. The number of network capillaries with the formation of loop-like capillary complexes and extensive non-vascular zones was significantly reduced (Fig. 1.A, B, C — chronic immobilization stress (group 5). Rat sternum. Vascular-neural bundle. Stained with hematoxylin and eosin. UV. × 400 The following are determined: vascular dystonia, uneven congestion, swelling of the vascular wall (A), aggregation (sludge) of red blood cells, and their adhesion to the vascular wall, microthrombi (B, C), perivascular edema, metachromasia of the vascular wall, vacuolization of nerve elements (B)) .

Thus, the transformation of ICR during immobilization stress manifested itself in dystonia, a rarefaction of the bone capillary network - up to the appearance (in chronic stress) of avascular zones.

The overall outcome of microcirculation disorders during immobilization stress was the development of ischemia and hypoxia of bone tissue of varying severity.

The state of cartilage tissue under conditions of chronic immobilization stress was characterized by signs of vacuolization of the nuclei of chondrocytes and metachromasia of their cytoplasm (figure 2 - chronic immobilization stress (group 5). Hyaline cartilage of the sternum of the rat. Uv. × 400. Staining with hematoxylin and eosin. Determined: vacuolization metachromasia of the cytoplasm of chondrocytes.).

When using electromagnetic waves at the frequencies of MSPIOA 150.176-150.664 GHz, an effective restoration of microangioarchitectonics, especially of the capillary link, to values close to the corresponding indices of intact animals of group 9 was observed.

The most optimistic in terms of the degree of normalization of blood flow in the bone marrow transplantation were the results obtained in groups 3 and 7 of experimental animals.

In 3 and 7 experimental groups of animals, when applying electromagnetic waves at frequencies of the molecular absorption spectrum of nitric oxide 150.176-150.664 GHz for 15 minutes against the background of acute and chronic immobilization stress, a positive dynamics of the restructuring of the angioarchitectonics of the vascular networks of bone tissue with a noticeable dilation, decrease dystrophy of the elements of the vascular wall. At the same time, tortuosity, dystonia decreased, the uniformity of the distribution of blood vessels was restored with a decrease in low-vascular zones, and the balance between the links of blood inflow and outflow was restored with a change in the number and type of organization of blood vessels.

In parallel with the signs of normalization of bone blood flow, the reaction of the marginal standing of leukocytes decreased, primarily in the collective venules. The correction of changes in the vascular link was evidenced by a marked decrease in the tortuosity of postcapillaries and individual venules. In the majority of the studied objects, signs of impaired capillary permeability were not detected (Fig. 3 — acute immobilization stress with the use of EMR for 15 minutes (group 3). CMC and bone tissue of the sternum of the rat. Stained with hematoxylin and eosin. UV. × 400. Maximum correction is determined. functional and metabolic disorders).

Evaluation of histological indicators of the status of rat bone tissue ICR in the 7th experimental group revealed their correlation with the maximum approximation to similar indicators in intact animals of the 9th group.

The state of hyaline cartilage also approached normal in animals of this group (Fig. 4 - chronic immobilization stress using EMR for 15 minutes (group 7). Hyaline cartilage of the sternum of the rat. Uv. × 400. Stained with hematoxylin and eosin. It is determined that the condition cartilage approaching normal).

An analysis of the results of an experimental study confirmed the effectiveness of our proposed method for correcting violations of bone microcirculation and the state of cartilage.

Our proposed method was used in the complex treatment of 30 patients with deforming arthrosis of the knee joints (main group). The comparison group consisted of 32 patients with a similar pathology, in the complex treatment of which EHF-therapy apparatus "Yav-1" was used, at a frequency of 53.534 GHz (5.6 mm) or 42.194 GHz (7.1 mm). The age of patients ranged from 45 to 67 years. Both groups of patients were comparable in gender, age, and the nature of the concomitant pathology. The main complaints were pain, stiffness and limitation of the range of motion in the knee joints. In order to clarify the nature and severity of pathological changes in the affected joints, all patients underwent standard radiography and ultrasound (ultrasound) (using the LOGIC-400 MD linear sensor 6-9 MHz). Ultrasound of the knee joints was performed twice: before and after the course of treatment. As comparative criteria, we took into account: the severity of pain during walking on a 100 mm visual analogue scale (VAS), the degree of limitation of the amplitude of joint movements compared with the physiological norm, the frequency of synovitis and edema of paraarticular tissues. The results are presented in the table.

In the comparison group receiving EHF therapy with the Yav-1 apparatus, a decrease in the severity of pain and an increase in the amplitude of movements were observed after a 7-8 session, and in 4 patients after 3 treatments an increase in pain was noted. The severity of pain in patients of this group decreased by 2.4 times, the amplitude of movements increased by an average of 6.1 °, the incidence of synovitis decreased by 2.7 times, and the frequency of occurrence of edema of paraarticular tissues - by 4 times.

In the main group of patients who received EHF-therapy in accordance with our proposed method, a decrease in the severity of pain and an increase in the amplitude of movements in 24 people was noted after 3-4 procedures. An increase in pain was not observed in any case. The severity of pain in patients of the main group decreased by 3.9 times, the amplitude of movements increased by an average of 9.2 °, the incidence of synovitis decreased by 4.3 times, and the incidence of edema of paraarticular tissues was 4.7 times. The total time spent on EHF-therapy in patients of the main group was 3 times less than in the control group of patients.

In a comparative analysis of the data obtained, it was noted that in patients of the main group, the positive dynamics of the studied parameters was significantly better in comparison with patients in the comparison group. The use of EHF-therapy at the frequency of MSPIOA in the complex treatment of patients with DOA allows to obtain a clinical effect faster than when using EHF-therapy at a frequency of 53.534 GHz (5.6 mm) or 42.194 GHz (7.1 mm) and to avoid undesirable complications.

Clinical example.

Patient B., 52 years old, was hospitalized at City Clinical Hospital No. 2 due to an exacerbation of deforming arthrosis of the right knee joint, art. (taking into account the data of the x-ray of the right knee joint - figure 5) from 09/10/09 to 09/30/09

At the time of treatment, the patient complained of pain in the right knee joint at rest, aggravated by walking (53 mm according to YOUR), limitation of the range of motion of this joint, limitation of working capacity.

During the examination of the patient were noted: local pain on palpation of the paraarticular tissues of the right knee joint, limitation of the amplitude of the movements of this joint in the direction of flexion - extension by 24 °, synovitis and edema of the paraarticular tissue.

Along with the standard regimen of drug and rehabilitation treatment, EHF therapy was included in the rehabilitation complex of patient B. in accordance with the method we proposed. The duration of the course was 10 sessions. Irradiation was carried out in 3 areas: in the projection of the medial, middle and lateral areas of the gap of the right knee joint.

When assessing the immediate results of treatment, a clear positive trend was noted. The pain syndrome at rest completely stopped, persisted only with a load (15 mm according to YOUR). Palpation of paraarticular tissues was painless. The amplitude of the movements of the right knee joint in the direction of flexion - extension increased by 13 °. The phenomena of synovitis and edema of paraarticular tissues were completely stopped. After completing the course of treatment, the patient continued her professional activities.

Thus, the analysis of the obtained data allowed us to conclude that the application of the proposed method for the treatment of patients with deforming arthrosis using EHF-therapy at the frequency of MSPIOA allows us to achieve correction of bone microcirculation disorders and the state of cartilage, to reduce the total time of EHF-therapy by 3 times, reduce the complexity of the method, and also get a positive clinical effect faster than when using EHF-therapy at a frequency of 53.534 GHz (5.6 mm) or 42.194 GHz (7.1 mm) and avoid undesirable slozhneny.

Claims (1)

A method for treating patients with deforming arthrosis, including irradiating the joint region with EHF radiation, characterized in that they are exposed to EHF radiation at a frequency of the molecular absorption spectrum and radiation of nitric oxide of 150.176-150.664 GHz, power density 0.2 mW / cm ² for 5 min for 3 sections skin located in the projection of the medial, middle and lateral region of the joint space, daily for 10 days.

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