RU2441639C1 - Method for treatment of children with chronic synovitis after arthroscopy - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention is referred to the field of medicine, namely to pediatrics and physical therapy. The method includes the exposure to silt sulphide dirt of Saki lake and constant continuous current. The dirt used in the process is placed in hydrophilic fabric bags-pads. The pads that are 3-5 cm thick, sized 10x16 cm, with the temperature 5-10C, are placed on lateral and medial surface of operated knee joint. 2 electrodes sized 180 x 120 mm are placed on them. They are fixed with elastic bandages. Then constant continuous current is sent to the electrodes from Ç£Potok-1Ç apparatus. With current power 0.02-0.08 mA the exposure time is 8-10-15 minutes. The procedures are performed daily. The course includes 8-10 procedures. ^ EFFECT: method provides for increased effectiveness of treatment, decreased pain syndrome, increased lymph flow speed, normalizes the parameters of venous flow, provides anti-edema and anti-inflammatory action, improves nutrition and regeneration of tissues, decreases hardening and fibrosis of tissues, shortens the terms of treatment and rehabilitation. ^ 1 dwg, 2 ex, 5 dwg

Description

The present invention relates to medicine, in particular to pediatrics, namely to traumatology, and can be used in medical institutions for the treatment of children with chronic synovitis after arthroscopy.

Currently, the treatment of children with chronic synovitis after arthroscopy is complex, aimed primarily at treating postoperative edema, detonating and eliminating stagnation in tissues, combating inflammation in tissues, accelerating interstitial metabolism, relieving pain, restoring the range of motion of an injured limb, and correcting vascular disorders, resulting in a significant reduction in the length of hospitalization and further rehabilitation.

Known methods for treating children with chronic synovitis after arthroscopy, which include: therapeutic immobilization (operative - internal osteosynthesis with metalwork; non-operative - gypsum longets), drug therapy (antibiotics, desensitizing drugs, painkillers), physiotherapy exercises and muscle massaging, healthy segment muscles -reflex zone, drainage massage above and below the site of damage, various methods of apparatus physiotherapy.

However, the main disadvantages of these methods of treatment are the excessive duration of the treatment with simultaneous significant physical exertion, their repeated occurrence, which requires significant volitional efforts on the part of the child, and this in turn entails rapid fatigue and the occurrence of undesirable negative reactions on the part of the a child. As a result, the degree of effectiveness of the treatment is reduced.

There are also known methods of treating children with chronic synovitis after arthroscopy in the postoperative period by applying physical factors, such as in the early period of the disease, magnetic therapy to the area of damage with the aim of anti-edematous anti-inflammatory action, to reduce pain. Inductors or solenoids are placed transversely or along the limb, magnetic induction 10-12 MT, duration 10-15 minutes, daily, for a course of 10-12 procedures.

In order to accelerate metabolic processes, unload tissue from venous stasis and lymph, ultraviolet irradiation of the affected limb with fields, 1-4 biodoses, daily or every other day, for a course of treatment of 5-6 exposures; ultraviolet irradiation of the segmental zone (lumbar or collar) of 1-2 biodoses, after 2-3 days, for a course of treatment of 3-4 exposures (Umarova Kh.T., Karachevtseva TV. Physiotherapy in pediatrics. 1993). However, with these treatment options, we do not achieve the desired decongestant and anti-inflammatory effect, and when exposed to an affected limb, it is technically possible to carry out this only under dressing conditions. The disadvantage of these methods is their least effectiveness anti-inflammatory, decongestant action.

Closest to the technical nature of the proposed method is a method of treatment in the postoperative period of children with chronic synovitis, based on the use of novocaine electrophoresis at a later stage of rehabilitation.

The current strength is selected individually. The course of treatment is 10-15 procedures (Umarova Kh.T., Karachevtseva T.V. Physiotherapy in pediatrics. 1993).

The disadvantages of this method are the lack of the most accurate impact on the pathological zone, the likelihood of an irritating effect under the electrodes and the development of allergic reactions are not excluded, and the negative reaction (tearfulness, fear) in a child to this kind of effect cannot be completely excluded.

The technical result of the proposed method is to increase the effectiveness of treatment, reduce pain, increase the rate of lymph outflow, normalize the parameters of venous outflow, anti-edematous and anti-inflammatory effects, improve nutrition and regeneration of various body tissues, reduce sclerosis and tissue fibrosis, reduce the length of hospitalization and the timing of further rehabilitation.

The specified technical result is achieved by exposing the patient to packaged silt sulphide mud of Lake Saki, placed in hydrophilic cloth bag-liners, and constant continuous current from the apparatus "Potok-1", while laying 3-5 cm thick, 10 × 16 cm in size, temperature 5-10 ° C is placed on the lateral and medial surfaces of the operated knee joint, 2 contact electrodes from the Potok-1 apparatus are placed on them, fixed with elastic bandages, while the current strength is from 0.02-0.08 mA, individually for eachatsienta, exposure time 8.10.15 minutes, depending on the age of the child, in the course of 8-10 daily procedures, the position of the patient lying or sitting.

The difference between the effects of direct continuous current and chilled packaged mud is the selective selectivity of the action on the permeability of histohematological barriers. The latter is accompanied by an increase in the formation and release into the general circulation of physiologically active substances of chilled packaged mud due to the mineral and colloidal composition. With a physiological increase in the permeability of the histohematological barrier due to the cooling of the skin, the flow of nutrients and oxygen to the cells increases, as well as the removal of metabolic products, resulting in improved trophic tissue, anti-inflammatory, desensitizing and regenerating effects of dirt. The indicated technique for combining constant continuous current and chilled packaged mud to affect the permeability of the histohematological barrier, lymphatic and venous systems has not been applied until recently due to the lack of necessary technical capabilities. In the process of carrying out this method of treatment, the whole range of knowledge of the anatomy and physiology of the musculoskeletal system, lymphatic and venous systems was taken into account, which was reflected in the methods of applying electrodes and therapeutic programs.

DESCRIPTION OF THE METHOD OF TREATMENT

When performing the method, the patient is in a supine position. Packaged silt sulphide mud from Lake Saki is used, placed in hydrophilic cloth bags, gaskets and direct current electrodes from the Potok-1 apparatus. Gaskets 3-5 cm thick, 10 × 16 cm in size, 5-10 ° C temperature are placed on the lateral and medial surfaces of the operated knee joint, 2 contact electrodes 180 × 120 mm in size from the Potok 1 apparatus are placed on them, fixed with elastic bandages . The exposure is carried out by a constant continuous current of low frequency up to 1 mA. The current strength is from 0.02-0.08 mA, individually for each patient, the exposure time is 8-10-15 minutes, depending on the age of the child, per course of 8-10 daily procedures, the patient’s position while lying or sitting.

EXAMPLES OF IMPLEMENTING THE METHOD

Example 1

Dmitry L., 16 years old, was admitted to the trauma department of Children's Clinical Hospital No. 13 named after MF Filatova with a diagnosis of Post-traumatic synovitis of the left knee joint.

Complaints on admission: moderate pain in the left knee joint when walking.

Anamnesis of this disease: 1 year ago, the child received an injury to the left knee joint, since then pain during exercise has been disturbing, and joint blocks occasionally occur.

According to ultrasound from 04.24.09: joint chondropathy, chondromalacia of the patella, degenerative changes in the medial meniscus with signs of partial damage, Becker cyst. According to MRI from 06/15/09: MR signs of an intra-articular impression-comminuted fracture of the internal condyle of the femur. Traumatic damage to the posterior horn of the medial meniscus. Synovitis of the left knee joint.

On the radiograph from 04/02/09: no bone-traumatic changes were detected.

Local status: visually the left knee joint is not changed. No patellar ballotation, palpation of the joint area is moderately painful.

Operation: Arthroscopy. 29.06.09: Scanty effusion, synovial. The synovial membrane is edematous, injected with vessels with elements of the “pannus”, the upper inversion with multiple friable adhesions. The remaining structures of the joint are not changed. A biopsy of the synovial membrane was taken from the upper inversion and the anterior joint in the lateral condyle. After the operation, upon examination, the child's condition is satisfactory, complaints of moderate pain in the area of the operated knee joint, are not in a fever. Local status: moderate swelling of the knee joint. Seams are wealthy, there is no detachable. An aseptic dressing with levomekol, a plaster cast to the level of the lower third of the leg and lower third of the thigh was applied.

Before the first procedure, a study was carried out with infrared thermography before treatment, then after 5 procedures and after 10 procedures. (Fig. 1, 2, 3).

The procedure was as follows: the patient is in a supine position. Packaged silt sulphide mud from Lake Saki was used, placed in hydrophilic cloth bags, and electrodes of constant continuous current from the Potok-1 apparatus. Gaskets 3-5 cm thick, 10 × 16 cm in size, 5-10 ° C temperature were located on the lateral and medial surfaces of the operated knee joint, 2 contact electrodes 180 × 120 mm in size from the Potok 1 apparatus were placed on them, fixed with elastic bandages . The impact was carried out by a constant continuous current of low frequency up to 1 mA. Current strength from 0.02-0.08 mA, exposure time 10-15 minutes, 10 daily procedures.

Tolerance of the procedures is good, no complaints. Already from a 2-3 treatment session, an improvement in the general condition was noted, which was characterized by a significant decrease in pain, swelling of the joint, and a local increase in the temperature of the joints. By the end of the course, relief of pain was observed, after removing the bandages of edema, there was no hyperemia. There were no signs of inflammation. Postoperative healing by first intention, sutures were removed on the 5th day. Palpation of the joint area is painless. No patellar ballotation. The child was discharged in satisfactory condition in a plaster cast. At the end of the course, an assessment of the state of the muscular-connected apparatus by ultrasound revealed the disappearance of synovitis, and excess fluid in the joint was not determined.

The use of dynamic infrared thermal mapping after the course revealed that the decrease in pain in the joints after the course of electrophoresis of chilled packaged mud correlated with the normalization and reduction of skin temperature in the joint area that was elevated before treatment.

Example 2

Turpal-Ali., 13 years old, was admitted to the trauma unit of Children's Clinical Hospital No. 13 named after MF Filatova with a diagnosis of Longitudinal rupture of the posterior horn of the lateral meniscus of the right knee joint. Post-traumatic synovitis of the right knee joint.

Complaints at admission: pain in the right knee joint when walking, limitation of movements in it.

Anamnesis of this disease: Trauma - 1 year ago, there was a sharp pain in the right knee joint. Received conservative treatment. Repeated injury on September 7, 2009, since that time there was pain in the right knee joint when walking, limitation of movements. Appealed to the CDC DGKB number 13, was hospitalized in the 2nd surgical department with a diagnosis of suspected rupture of the medial meniscus of the right knee joint, mechanical block of the joint, in an emergency.

According to MRI from 09/15/09: linear T2 HI hyperintensive signal from the anterior horn of the lateral meniscus, going obliquely from the bottom and back up and forward, which indicates a possible damage to the anterior horn of 3 degrees. The body of the medial meniscus has a diffuse iso-intensive signal T1 VI and an increased signal in the T2 VI mode with suppression of fluid, which may indicate mucosal degeneration of the body of the medial meniscus. The remaining structures of the knee joint are without features.

On the radiograph from 09/14/09: no bone-traumatic injuries of the right knee joint were detected.

Local status: a slight paraarticular edema is visually noted. The symptom of ballotting of the patella is doubtful. Pain on palpation in the projection of the joint gap on the medial and lateral surfaces of the joint is determined. Soreness under the patella when it is displaced.

Operation: Arthroscopy. 09/16/09: There is no effusion. A longitudinal rupture of the posterior horn of the lateral meniscus was revealed. The synovial membrane is edematous, injected with vessels with elements of the “pannus”, the upper inversion with multiple friable adhesions. The remaining structures of the joint are not changed. Hydrocortisone 75 mg + lidocaine 2% was introduced into the joint cavity. An elastic bandage is applied. After the operation, upon examination, the child's condition is satisfactory, complaints of moderate pain in the area of the operated knee joint, not fever. Local status: moderate swelling of the knee joint. Seams are wealthy, there is no detachable. An aseptic dressing is applied, an elastic bandage to the level of the lower third of the leg and lower third of the thigh. In the department, the child received nimesulide 100 mg × 2 per day for 2 days. Dressings were performed.

Ultrasound of the knee joints from 09/17/09: the thickness of the soft tissues at the level of the upper third on the right is 30 mm, on the left - 24 mm, the front horns of the menisci are not changed. The tendon of the 4-headed thigh muscle on the right is 10 mm, on the left is 8 mm, fluid in the joint cavity is not determined. The posterior horns of the lateral and medial meniscus are echo-homogeneous, of medium echogenicity, blurring of their contours is noted. Before the first procedure, a study was carried out with infrared thermography before treatment, after 10 procedures. (Fig. 4, 5).

The procedure was as follows: the patient is in a sitting position. Packaged silt sulphide mud from Lake Saki was used, placed in hydrophilic cloth bags, and electrodes of constant continuous current from the Potok-1 apparatus. Gaskets 3-5 cm thick, 10 × 16 cm in size, 5-10 ° C temperature were located on the lateral and medial surfaces of the operated knee joint, 2 contact electrodes 180 × 120 mm in size from the Potok 1 apparatus were placed on them, fixed with elastic bandages . The impact was carried out by a constant continuous current of low frequency up to 1 mA. Current strength from 0.02-0.08 mA, exposure time 10-15 minutes, 10 daily procedures.

Tolerance of the procedures is good, no complaints. Already from a 2-3 treatment session, an improvement in the general condition was noted, which was characterized by a significant decrease in pain, swelling of the joint, and a local decrease in elevated temperature of the joint. By the end of the course, relief of pain was observed, after removing the bandages of edema, there was no hyperemia. There were no signs of inflammation. Postoperative healing by first intention, sutures were removed on the 5th day. Palpation of the joint area is painless. Symptom of patellar ballotation is negative. Paraarticular edema is negligible. The child was discharged in satisfactory condition in an elastic bandage.

At the end of the course, an assessment of the state of the muscular-connected apparatus by ultrasound revealed the clarity of the posterior horn of the lateral and medial meniscus, echo-homogeneous, medium echogenicity, and excess fluid in the joint was not determined.

The use of dynamic infrared thermal mapping after a course of electrophoresis of chilled packaged mud revealed a decrease in skin temperature in the joint area that was elevated before treatment.

The proposed method was first applied in the postoperative period of treatment in 30 children aged 5 to 17 years with various pathologies: damage to the medial meniscus, post-traumatic synovitis, damage to the lateral meniscus, longitudinal rupture of the posterior horn of the lateral meniscus, partial rupture of the posterior horn of the inner meniscus, etc. base of the Department of Traumatology and Orthopedics DGKB number 13 named. N.F. Filatova. As a result of the application of the proposed method of treatment in children with chronic synovitis after arthroscopy, a favorable effect of electrophoresis of chilled packaged mud on the clinical course of the disease, a pronounced decongestant effect, and anti-inflammatory effect were observed. According to infrared thermography, thermo-asymmetry phenomena decreased in 74% of patients. According to the ultrasound examination of the joints, the symptoms of synovitis disappeared, the excess fluid in the joint was not determined. The difference in circumference of the damaged and symmetrical limb on average decreased by 0.5-2 cm, towards the end of the course; reduction of pain syndrome, removal of spasm of peripheral arteries, normalization of venous outflow, improved nutrition and tissue regeneration in the postoperative area, reduction of tissue sclerosis and fibrosis.

As a result of the course, the periods of hospitalization (on average by 5-6 days) and further rehabilitation of children with chronic synovitis after arthroscopy were significantly reduced.

Claims (1)

A method of treating children with chronic synovitis after arthroscopy by exposure to low-frequency direct current, characterized in that the patient is affected by packaged silt sulphide mud of Lake Saki, placed in hydrophilic cloth bags-pads, and constant continuous current from the "Potok-1" apparatus, pads 3-5 cm thick 10 × 16 cm in size and 5-10 ° C are placed on the lateral and medial surfaces of the operated knee joint, 2 contact electrodes 180 × 120 mm in size are applied to them , fixed with elastic bandages, with a current strength of 0.02-0.08 mA, the exposure time is 8-10-15 minutes, 8-10 daily procedures.

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