RU2427398C1 - Method of treating patients with bone fractures - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention refers to medicine, namely - to traumatology, physiotherapy. A method involves EHF-exposure on a fracture region. The EHF electromagnetic irradiation is executed at a molecular spectrum frequency of nitrogen oxide radiation and absorption 150, 176-150, 664 GHz. Said exposure covers a state of bone tissue microcirculation. The power density is 1 mWt/cm2. The exposure takes 15 minutes daily, for 10 days. ^ EFFECT: method reduces time of fracture treatment due to a stimulating effect on bone tissue repair processes in an immediate postoperative period. ^ 1 ex, 5 dwg, 1 tbl

Description

The invention relates to medicine, in particular to traumatology and physiotherapy, and can be used to treat patients with bone fractures.

One of the key pathogenetic links that determine the severity of catabolic processes in bone tissue during injuries is a violation of bone microcirculation. The development and implementation of effective methods for correcting disorders of bone microcirculation, as one of the components of the pathogenetic therapy of skeletal bone fractures, is an urgent task of modern traumatology.

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 // Vopr. 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 from 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 effect 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 // Vopr. 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 practice, 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 effects 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 (EMP) of various wavelengths has long been used, but only relatively recently has begun the use of millimeter-wave EMP, which includes 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 bone fractures, 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: in case of fractures over the area of bone fracture. The duration of the session is 30 minutes 1-2 times a day, the course of treatment is 10-20 sessions. [Karlov V.A., Reznikov K.M. EHF therapy for fractures of long bones. In the book: VII All-Union Seminar "Application of EHF radiation of low intensity in biology and medicine". Thes. doc. M .: IRE AN SSSR; 1989. Reznikov K.M., Nekhaenko N.E. Quantitative assessment of the effect of EHF therapy in patients with fractures of the leg. Questions of balneology, physiotherapy 1997; 3: 25-26.]

The disadvantage of this method is the reflex principle of exposure to the central and peripheral mechanisms of microcirculation regulation, which does not always allow one to rely on the effectiveness of this type of exposure in relation to areas of bone tissue with impaired microcirculation due to injury. 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.

The authors proposed a method for treating patients with bone fracture, including irradiating the fracture region 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 1 mW / cm ² for 15 minutes daily in within 10 days.

The advantage of the 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 to activate the metabolic and reflex effects of nitric oxide (OA), which is one of the main factors in the regulation of hemorheological and vascular units of microcirculation. 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 the proposed method has a penetration depth into biological tissues of up to 50 mm, which ensures maximum impact efficiency directly in the fracture area.

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 skin surface of 3 cm ² above the fracture area is irradiated. The irradiator is located at a distance of 1.5 cm above the surface of the skin. The radiation power of the generator is 0.7 mW, and the power density incident on a skin area of 3 cm ² is 1 mW / cm ² . The total duration of a single exposure is 15 minutes. The number of radiation sessions per treatment course is 10.

The effectiveness of the proposed method is confirmed by the first 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 IV, 1980] and to the action of EMR of various ranges [Grabovskaya E.Yu., 1992; Chuyan E.N., 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 postcapillaries, 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 the vascular contours 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 (Fig. 1.A, B, C — chronic immobilization stress (group 5). Sternum of the rat. Vascular-neural bundle. Vascular dystonia, uneven plethora, swelling of the vascular wall significantly decreased). 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). Stained with hematoxylin and eosin. UV. × 400).

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.

When using electromagnetic waves at the frequencies of the molecular spectrum of radiation and absorption of nitric oxide (150, 176-150, 664 GHz), an effective restoration of microangioarchitectonics, especially 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 the frequencies of the molecular spectrum of radiation and absorption (MSIP) 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 angioarchitectonics of the vascular networks of bone tissue with their noticeable dilatation, reducing 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 (Fig. 2 - acute immobilization stress with the use of EMR for 15 minutes (group 3) The red bone marrow and bone tissue of the sternum of the rat. The maximum correction of functional and metabolic disorders. Stained with hematoxylin and eosin. Uv. × 400; figure 3 - acute immobilization stress with application of EMR for 15 minutes (group 3). Thigh of a rat. Normalization of metabolic processes and tinctorial properties of the bone matrix (slightly metachromated extracellular substance is practically normal). Stained with hematoxylin and eosin. UV. × 400).

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 indicated by a marked decrease in the tortuosity of postcapillaries and individual venules. In most of the studied objects, there were no signs of impaired capillary permeability.

Evaluation of histological indicators of the status of rat bone tissue ICR in the 7th experimental group showed their correlation with the maximum approximation to the same indicators in intact animals of the 9th group (Fig. 4 - chronic immobilization stress using EMR for 15 minutes (7th group). Thigh of the rat. Normalization metabolic processes and tinctorial properties of the endosteal tissue of the thigh. Stained with hematoxylin and eosin. UV. × 400)

Analysis of the results of an experimental study confirmed the effectiveness of the proposed method for the correction of disorders of bone microcirculation.

The proposed method was used in the treatment of 18 patients with fractures of the ulnar process (1 group). The comparison group consisted of 15 patients (group 2), in the treatment of which EHF therapy with the Yav-1 apparatus was used, at a frequency of 53.534 GHz (5.6 mm) or 42.194 GHz (7.1 mm). The choice of patients with this pathology to perform a comparative analysis was due to the fact that performing an open reposition of the fracture allows in most cases to achieve good quality. This excludes the effect of the quality of the reposition on the osteoreparative process in the fracture zone.

As a quantitative criterion for assessing the effectiveness of EHF therapy on the state of bone tissue in the fracture zone, an index of the degree of fracture fusion according to the optical density of the x-ray diffraction patterns determined by the method of A. B. Slobodsky was chosen.

It is known that the brightness of the image on the x-ray depends on the density of the tissues through which the x-ray passed. When digitizing, the x-ray image is divided into many small elements - pixels. The brightness of each pixel can have one of 256 levels, with "0" corresponding to completely black, and "255" to absolutely white. To measure the brightness of the areas of the x-ray, you can use the Histogram function of the well-known image processing program Adobe Photoshop. The Histogram function for the selected image section builds a histogram - a graph of the dependence of the number of pixels of a certain brightness on the value of this brightness. In addition, this function calculates the average brightness of the plot, the standard deviation of the brightness and other parameters. The authors used the average brightness parameter to describe the brightness of various parts of the image.

Due to the fact that radiographs have various qualitative characteristics (brightness, contrast, clarity, etc.), an objective approach is proposed for an objective analysis of the degree of fracture consolidation. The following values are determined on a digital x-ray of the fracture region, performed immediately after osteosynthesis and reposition of bone fragments: B0 is the brightness of the soft tissue site in the immediate vicinity of the fracture, B1 is the brightness of the portion of the intact bone in the immediate vicinity of the fracture, and BX is the brightness of the fracture zone. We calculate the initial relative brightness of the fracture zone:

and accept that this value corresponds to a degree of consolidation of 0%.

Upon completion of the consolidation of the fracture, the brightness of the site of the fused fracture BX will coincide on the radiograph with the brightness of the intact bone B1. Therefore, the final relative brightness is:

and its degree of consolidation is 100%.

Then the degree of consolidation of cons at an arbitrary point in time of treatment can be determined by the formula:

where x is the relative brightness of the fracture site, determined by x-ray at the same time.

The proposed approach allows us to reliably determine the degree of consolidation, regardless of the brightness and contrast of the x-ray image. The only condition is that all x-rays of the fracture area must be made in the same projection as the initial image.

Based on the foregoing, a study was made of the optical density of digitized radiographs in patients with fractures of the ulnar process. The data obtained are presented in table 1.

Table 1 The value of the optical density of the fracture zone in patients with fractures of the ulnar process Patient group (EHF therapy method) N - number of patients The optical density of the fracture zone immediately after osteosynthesis The optical density of the fracture zone 2 weeks after osteosynthesis The optical density of the fracture zone 1 month after osteosynthesis. 1 group N = 18 (the proposed method of EHF therapy) 78 ± 4,5% 71 ± 5.1% 96 ± 3.7% Group 2 N = 15 (Prototype method of EHF therapy using the device "App") 77 ± 4.8% 65 ± 6.9% 89 ± 7.1%

An analysis of the results shows that the indicator of bone optical density in the fracture zone immediately after osteosynthesis did not have significant differences, which confirms similar results of the quality of reposition in both groups of patients. Bone tissue resorption in the fracture zone in patients of the second group was more pronounced compared with the first group. This is evidenced by the fact that the indicator of bone optical density in the fracture zone after two weeks in patients of the first group decreased by 7%, while in patients of the 2nd group - by 12%. In addition, the optical density of the fracture zone in patients of group 1 1 month after osteosynthesis was 7% higher than that of patients in group 2 and was close to normal (96 ± 3.7%). It should also be noted that the studied parameter in patients of the 1st group had a significantly smaller variation range in comparison with the patients of the 2nd group. This was probably due to the fact that not all patients of group 2 had a therapeutic effect of EHF therapy. In addition, the average duration of EHF therapy treatment procedures in patients of group 1 was 2.5 hours, while in patients of group 2, the average duration of EHF therapy was 7.5 ± 0.5 hours (3 times more compared to 1 group).

Clinical example

Patient K., 54 years old, was hospitalized at City Clinical Hospital No. 2 for a fracture of the right ulnar process from 4.01.08 to 12.01.08. On 6.01.08, an operation was performed: open reposition, osteosynthesis of the right ulnar process with knitting needles and tightening wire loop.

Along with the standard regimen of drug and rehabilitation treatment, EHF therapy was included in the rehabilitation complex of patient K. in accordance with the proposed method. The duration of the course was 10 sessions. Irradiation was performed on the fracture area of the ulnar process of the right ulnar bone.

Healing of the surgical wound occurred by primary intention. Evaluation of the immediate result of treatment (1 month after surgery) corresponded to the “good” indicator. The complete consolidation of the fracture was ascertained, which is confirmed by the data of control radiography (Fig. 5).

The optical density of the bone in the fracture area two weeks after surgery was 75.3%, and after 1 month - 98.4%.

Thus, the results of the study confirmed that the proposed method of EHF treatment of patients with bone fractures allows to achieve a corrective effect on the state of bone microcirculation and its metabolism in the fracture zone in more patients, reduce the total time of EHF therapy by 3 times, and reduce the complexity of the method in comparison with the known method of EHF therapy using the apparatus "Yav".

Claims (1)

A method of treating patients with bone fractures, including irradiating the fracture 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 1 mW / cm ² , 15 min each daily for 10 days.

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