RU2432973C1 - Method of treating patients with osteoarthrosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to arthrology, and can be used for treatment of patients with osteoarthrosis. For this purpose, patient is given combined EHF-IR therapy by performing impact on the region of affected joint in the same direction as joint space, in a stable manner according to transverse methods simultaneously by two irradiators. EHF irradiator provides impact with wavelength 5.6 mm, fixed frequency 53.5 GHz, pulse power of irradiation 10 mW. Light infrared irradiator provides impact with wavelength 0.7-1.2 mcm. Duration of procedure is 15 minutes. Treatment course includes 10 procedures, daily.

EFFECT: method increases efficiency of patients' treatment due to simultaneous impact with electromagnetic irradiation of extremely high frequency and infrared irradiation of selected parameters, which leads to improvement of patients' life quality and increase of their workability resulting from reduction of joint syndrome expression, improvement of functional joint activity, reduction of recurrences and complications of said disease.

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Description

The invention relates to medicine, namely to arthrology, and can be used for the complex treatment of patients with osteoarthrosis (OA) of the I-III stage of the process.

OA is one of the important health problems in all countries of the world, including Russia, since the frequency of OA diseases among the population is quite high and does not tend to decrease. OA of the knee joints attracts special attention due to the significant prevalence, progressive course and early disability, as well as the persistence of pain, which significantly impairs motor activity, quality of life and contributes to the development of depression. 25% of patients develop severe disability.

Since the possibility of modern methods in the treatment of osteoarthritis is insufficiently effective and limited, the search for new approaches, the development and improvement of rehabilitation methods, and the successful treatment of osteoarthrosis are relevant.

There is a method of treating patients with OA by applying the pharmacotherapeutic method with non-steroidal anti-inflammatory drugs (NSAIDs), analgesic, structurally modifying agents - chondroprotectors, drugs that improve microcirculation, glucocorticosteroids (Mazurov V.I., Onushchenko I.A. Osteoarthrosis / Clinical Guide for Rheumatology ( Practical Doctors) / Edited by Prof. V.I. Mazurov. St. Petersburg: Publishing House Foliant, 2005. S.411-416).

The disadvantage of this method is the low efficiency due to the occurrence of adverse reactions that threaten the health and life of patients with osteoarthritis. Features of the course of OA, in particular the chronic course, require long-term administration of drugs. This is a risk factor for the development of gastropathy, gastrointestinal bleeding, impaired renal function, platelet aggregation and other complications from vital organs and systems. The simultaneous administration of drugs of several groups, the presence of concomitant pathology (diseases of the cardiovascular system, kidneys, liver, bronchial asthma) also increase the risk of NSAID toxicity.

The closest technical result achieved is the method of treating patients with OA by the physiotherapeutic method, namely ultrasound therapy, in which the affected joint is exposed to mechanical vibrations of ultrahigh frequency (Private physiotherapy: a training manual / Edited by G.N. Ponomarenko. M .: Publishing House " Medicine ”, 2005. - S.201-202).

The disadvantage of this method is the low efficiency due to the occurrence of adverse reactions, since ultrasound therapy has a pronounced load on the body and has a number of contraindications when applied to bone protrusions (patella, ulnar process, condyle of the tibia and fibula, etc.).

The authors developed and proposed a highly effective method of non-drug treatment, which allows to reduce the severity of the joint syndrome, improve the functional activity of the joints, reduce relapses and complications of this disease, increase working capacity, and improve the quality of life of patients.

The technical result of the claimed invention is to increase the effectiveness of treatment of patients with osteoarthrosis.

The technical result is achieved by the fact that the patient is given daily combined EHF-IR therapy to the affected joint along the joint gap, contactally, stably according to the transverse technique simultaneously with two emitters: an extremely high frequency emitter with a wavelength of 5.6 mm, a fixed frequency of 53.5 GHz , a pulsed radiation power of 10 mW and a light infrared emitter with a wavelength of 0.7-1.2 μm, the duration of the procedure is 15 minutes, the course of treatment is 10 procedures, daily.

The effectiveness of the proposed method is confirmed by figures 1 and 2. Figure 1 presents an ultrasound examination of the knee joint before treatment. Figure 2 - ultrasound examination of the knee joint after treatment.

The method is as follows.

Against the background of complex treatment, consisting of medical massage, physiotherapy exercises, a course of EHF-IR therapy is carried out. For the treatment using the apparatus of the EHF-IR therapy "SEM TESN", performance BF No. FSO22227575 / 0879-04, manufactured by LLC Spinor, the city of Tomsk.

EHF-IR therapy is carried out in the morning, under medical supervision: measurement of blood pressure and heart rate (before and after the procedure). The treatment is carried out by electromagnetic radiation of the millimeter and infrared light ranges, the emitters are installed in a contact, stable manner on the projection area of the joint space by the transverse technique, i.e. one emitter is located on the medial surface of the joint, the second emitter is located on the lateral surface of the joint. The parameters are selected in such a way as to provide the greatest therapeutic effect in this disease, the pathogenesis of which is associated with a violation of the physiological and reparative tissue regeneration.

Treatment parameters: simultaneous exposure to two emitters: an EHF emitter with a wavelength of 5.6 mm, a fixed frequency of 53.5 GHz, a pulsed radiation power of 10 mW and a light infrared emitter with a wavelength of 0.7-1.2 μm, the duration of the procedure is 15 minutes , the course of treatment - 10 procedures, daily, except Saturday and Sunday.

The severity of the process in patients was assessed by the dynamics of pain, the degree of change in the functional state of the joints and the severity of synovitis. The examination of the patients included clinical and functional tests: 1 - the intensity of the pain syndrome according to the visual analogue scale (VAS), 2 - the degree of pain in the joints during palpation, 3 - the degree of swelling of the joint, determined by the increase in the circumference of the joint, 4 - restriction of movement in degrees, 5 - forced walking by 30 meters, 6 - time to climb the stairs 10 steps, 7 - time to go down the stairs 10 steps. The volume of passive and active movements in the knee joints was measured with a goniometer. The intensity of the pain syndrome was determined by palpation with a point score: 0 - no pain, 1 - slight pain in limited areas of the inner or outer surface of the joint, 2 - moderate pain in the projection of the entire joint gap, 3 - severe pain in the entire joint surface. Radiography of the knee joints in the front and lateral projections, rheovasography of the vessels of the legs, ultrasound examination of the knee joints, quality of life was studied using the Russian version of the questionnaire “Short Form-36 (SF-36) Health Status Questionnaire”.

Clinical studies have shown that after the course of treatment there was a significant dynamics of the clinical condition of patients.

After a course of complex treatment with the inclusion of EHF-IR therapy, almost all patients stopped or reduced pain, night pains and pains at rest disappeared, pain in the affected joint significantly decreased during exertion, there was a positive trend in complaints of morning stiffness, an increase in volume was observed movement. The conducted functional tests confirm the positive clinical dynamics of the manifestations of osteoarthrosis. When analyzing the dynamics of pain by YOUR after treatment, a significant decrease of 56.7% was found, an increase in the amplitude of movements was detected, a significant decrease in the travel time of a fixed distance by 18.0% was recorded. The time of climbing stairs by ten steps in the main group decreased by 16.4%, the time of descent by ten steps decreased by 15.5%. The volume of affected joints was significantly reduced.

According to rheovasography, after complex treatment with the inclusion of EHF-IR therapy, patients showed a significant increase in the rheographic index by an average of 19.6%, which indicates the normalization of pulse blood filling in the vessels of the lower extremities, a significant decrease in the dicrotic index by an average of 18.7 %, which reflects a decrease in peripheral vascular resistance. The diastolic index during treatment significantly decreased by an average of 19.2%, which indicates normalization of venous tone and an improvement in venous outflow.

After the course of treatment, analysis of the results of ultrasound studies showed that there was a significant positive dynamics in the parameters of this study. So, after complex treatment, a decrease in the thickness of the synovial membrane of the knee joint was recorded by 54.8%, the amount of effusion in the joint cavity decreased by 42.8%.

After the course of EHF-IR therapy, a significant improvement was recorded in both the physical and psychological and social functioning of patients according to the quality of life questionnaire (“SF-36”). Physical function, physical role especially increased, physical pain decreased, positive changes occurred in the psycho-emotional sphere, which corresponds to the subjective sensations of the appearance of internal energy, reduced fatigue, increased vitality, and level of communication. According to the claimed method treated 107 patients with OA.

Clinical example 1

Patient Baulina Raisa Kornilovna, 57 years old, turned to the physiotherapy department of the Municipal Healthcare Institution “City Hospital No. 4” with complaints of pain in the right knee joint, aggravated by climbing and descending stairs, night pains, limitation of mobility, swelling of the knee joint.

Diagnosis: Osteoarthrosis of the knee, stage II, chronic synovitis of the right knee. Concomitant diseases: Arterial hypertension of the II stage, II degree with a high risk of complications, polysegmental osteochondrosis, chronic relapsing course, abdominal obesity of II degree.

According to the ultrasound examination, a narrowing of the joint gap, marginal bone growths, the presence of homogeneous effusion in the joint, and a decrease in the height of the hyaline cartilage were observed.

A patient undergoing complex treatment underwent a course of EHF-IR therapy according to the claimed method for the area of the right knee joint in the amount of 10 procedures. Treatment parameters: simultaneous exposure to two emitters: an EHF emitter with a wavelength of 5.6 mm, a fixed frequency of 53.5 GHz, a pulsed radiation power of 10 mW and a light infrared emitter with a wavelength of 0.7-1.2 μm, the duration of the procedure is 15 minutes held daily except Saturday and Sunday.

Immediately after the course of treatment, the patient noted improvement in well-being, pain during movement decreased, night pains stopped, the symptoms of synovitis disappeared, the range of movements in the joint increased, the circumference of the joint decreased, which is objectively confirmed by a significant improvement in functional tests after the course of treatment, as well as instrumental indicators. According to rheovasography, blood circulation of the legs has significantly improved. According to the results of ultrasound, a decrease in the thickness of the synovial membrane of the knee joint was recorded. Figure 1 shows an ultrasound examination of the knee joint of a patient with signs of osteoarthritis and concomitant synovitis before treatment, figure 2 - ultrasound examination of the same patient after conservative treatment with the inclusion of EHF-IR therapy. From the analysis of ultrasound data after complex treatment with the inclusion of EHF-IR therapy, the positive dynamics of proliferative changes in the synovial membrane is visible, its thickness decreased from 6.2 mm to 3.7 mm.

Also, according to the results of the SF-36 mental and physical health questionnaire, a significant improvement in the patient’s quality of life was revealed according to the following indicators: “physical pain”, “physical activity”, “vitality”, “emotional role”, and “mental health”.

Clinical example 2

Patient Arapova Klara Romanovna, 65 years old, turned to the physiotherapy department of the Municipal Health Institution “City Hospital No. 4” with complaints of pain in the left ankle joint, aggravated by movement, exertion, especially when descending stairs, limiting movements, swelling of the joint.

Clinical examination prior to treatment revealed arthralgia and an increase in the circumference of the ankle joint, limitations in its movements (in degrees), an increase in the time of ascent and descent of the stairs. A moderate narrowing of the joint space, moderate subchondral osteosclerosis, and flattening of the articular surfaces were found radiologically.

Diagnosis: Osteoarthrosis of the left ankle joint stage II, chronic synovitis of the left ankle joint. Concomitant diseases: Arterial hypertension of the II stage, II degree with a high risk of complications, coronary heart disease, angina pectoris II functional class.

A patient undergoing complex treatment underwent a course of EHF-IR therapy in the area of the left ankle joint in the amount of 10 procedures. Treatment parameters: simultaneous exposure to two emitters: an EHF emitter with a wavelength of 5.6 mm, a fixed frequency of 53.5 GHz, a pulsed radiation power of 10 mW and a light infrared emitter with a wavelength of 0.7-1.2 μm, the duration of the procedure is 15 minutes . Procedures were performed daily, except Saturday and Sunday.

After a course of treatment, pain during movement stopped, a significant decrease in joint pain during palpation was noted, synovitis disappeared, as evidenced by such indicators as a significant decrease in its circumference (by 4.3 cm after treatment), the disappearance of muscle contractures and an increase in the amplitude of movement (by 15 degrees). After the treatment, the pain intensity significantly decreased according to YOUR results, the time of descent down the stairs, the time of passage of a fixed distance decreased.

The favorable dynamics of the functional state of the joints and the clinical manifestations of the disease under the influence of combined EHF-IR therapy indicates distinct positive changes in the chronic inflammatory process in the joints.

Thus, the claimed method of treating patients with stage I-III OA is highly effective, easy to use and can be used on an outpatient, inpatient, sanatorium-and-spa treatment setting.

Claims (1)

A method of treating patients with osteoarthritis by applying the physiotherapeutic method, characterized in that the patient is given daily combined EHF-IR therapy to the affected joint along the joint gap, contactally, stably according to the transverse method, simultaneously with two emitters: an EHF emitter with a wavelength of 5.6 mm, fixed with a frequency of 53.5 GHz, a pulsed radiation power of 10 mW, and a light infrared emitter with a wavelength of 0.7-1.2 μm, the duration of the procedure is 15 minutes, the course of treatment is 10 procedures, daily.

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