RU2455028C1 - Method of treating osteoarthrosis of knee - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely traumatology and orthopaedics, and is applicable for the purpose of treating the patients suffering osteoarthrosis of knee. That is ensured by introducing platelet rich autoplasma prepared 1-2 hours before the procedure and containing 725 to 3029 thousand/mcl of platelets (normally - 162 to 358 thousand/mcl) in the affected joint and paraarticular tissues. The autoplasma is activated with 0.25% CaCl₂ in the ratio 3:1, in the amount of 10-15 ml. The platelet rich autoplasma is introduced twice within the therapeutic course every 5-7 days.

EFFECT: method allows ensuring repair of knee tissues and paraarticular tissues due to stimulated metabolism and regeneration abilities of the affected joint by means of using the autologous growth factors and biologically active proteins contained in the prepared autoplasma.

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Description

The invention relates to medicine, in particular traumatology and orthopedics.

Known methods of treating osteoarthritis, in which drugs containing derivatives of hyaluronic acid (noltrex, synocrome, viscorneal ortho, ostenil, synvisc, suplazin, etc.) are injected into the joint (1. Lila AM Modern pharmacotherapy of osteoarthritis. // New St. Petersburg medical statements 2005. No. 1 (35) P.38-44 .; 2. Lopatina DV, Lobanov SV Clinical experience with the use of hyaluronic acid derivatives in the complex treatment of patients with deforming arthrosis of large joints. // Russian Medical Journal 2010 No. 11 (756) S.12-16; 3. Menshikova I.V. Sovremen new approaches to the diagnosis and treatment of osteoarthritis of the knee joint. // Diss. ... Dr. med. Sciences - M., 2010 .; 4. Dougados M., Nguyen M., Listrat V. .. Amor B. High molecular weight sodium hyaluronate (hyalectin) in osteoarthritis of the knee: a 1 year placebo-controlled trial. // Osteoarthritis and Cartilage, 1993, 1: 97-103).

With the introduction of hyaluronic acid preparations, the lubrication of the articular surfaces improves, the mechanical damage to the cartilage at the time of the functional load is reduced. However, currently existing drugs are exogenous substances, and polysaccharides of various molecular weights and origins, as well as different concentrations of sodium hyaluronate, are used for their production, and therefore there is always a risk of undesirable side effects, such as various allergic reactions, acute aseptic arthritis, acute synovitis, the development of acute gouty and pseudogouty arthritis. The clinically unproven effect of these drugs on the regenerative ability of the cartilage tissue of the joint, the short clinical effect, the high cost of drugs containing hyaluronic acid, as well as the relatively high incidence of side effects make it necessary to search for more effective and affordable methods of treating osteoarthritis of the knee joint.

Closest to the proposed method of treatment is the "Method of treatment of deforming osteoarthritis of large joints", in which a native autoplasma is introduced into the joint in an amount of 12-18 ml 2-3 times per treatment course with an interval of 4-5 days (Patent RU No. 2136249 C1, 1999 g.). We took him for a prototype.

However, this method of treating osteoarthrosis has several disadvantages. Native autoplasma contains an insignificant amount of platelets, which means that it does not contain enough secretory biologically active proteins that are actively involved in the healing and regeneration of tissues. When using native plasma, the problem of restoring the soft tissues of the joint and paraarticular tissues directly involved in the pathological process is not solved. With subsequent injections of stored autoplasma, the amount of biologically active substances, which are an energy and building substrate for joint tissues, decreases. Therefore, the proposed method cannot provide sufficient treatment for osteoarthritis of large joints.

The aim of the invention is to eliminate the above disadvantages of treating osteoarthritis due to the use of autologous growth factors and biologically active proteins to stimulate the metabolism and regenerative abilities of tissues of the affected joint, which leads to a decrease in the frequency of side effects and the achievement of a stable clinical effect.

To achieve a medical-technical result, the task is that plasma rich in platelets is injected into the joint and paraarticular tissues.

The treatment of osteoarthritis with a platelet-rich plasma activated with 0.25% CaCl ₂ in a ratio of 3: 1, as follows from the prior art, has not been previously described, which allows us to conclude that the applicant's proposal meets the “novelty” criterion.

The method is as follows.

To obtain platelet-rich autoplasma, 1-2 hours before manipulation, blood is drawn from a cubital vein into special disposable plastic sacs of a hemacona with a capacity of 450 ml containing 63 ml of citrate-based anticoagulant. The platelet count in which is from 162 to 358 thousand / μl (an average of 256 thousand / μl). Blood is centrifuged on a PC rotary centrifuge for 6-7 minutes at 2500 rpm. The autoplasma obtained in the supernatant is subjected to second centrifugation for 30 minutes at 3000 rpm. After that, platelet-poor autoplasma is removed, with the extraction of 15-20 ml of platelet-rich autoplasma. The platelet content in the obtained autoplasma is from 725 to 3029 thousand / μl (an average of 1354 thousand / μl). The resulting erythrocyte mass is returned to the bloodstream. The resulting platelet-rich autoplasma is mixed with a 0.25% CaCl ₂ solution in a 3: 1 ratio. External access, after local anesthesia of the skin, produces a puncture of the knee joint with the introduction of 10 ml of platelet-rich autoplasma into the joint cavity. Then 4-5 ml of platelet-rich autoplasma is injected into the most painful areas of paraarticular tissues, which are determined by palpation. The described procedure is carried out 2 times with an interval of 5-7 days.

Clinical example

Patient Zolotarev V., 45 years old, was admitted to the trauma department on 08/16/2009 with complaints of pain in the right knee joint, restriction of movements. Pain occurs when walking, when standing for a long time, when climbing stairs. He had a history of trauma - at the age of 43, he received an intra-articular comminuted fracture of the condyles of the tibia, with a defect in bone tissue. For what the operation was performed - closed reposition, transosseous compression-distraction osteosynthesis according to Ilizarov. Joint pain began to be disturbed after 5 months, immediately after the dismantling of the external fixation apparatus and the onset of axial load on the limb. The increase in pain is noted after going to work, especially after prolonged standing, as the patient works as a machinist in a concrete production. He systematically underwent outpatient treatment at the clinic at the place of residence with the use of analgesics, physiotherapy and repeated administration of diprospan into the joint cavity, the treatment had a short clinical effect, there was no complete disappearance of pain. An objective examination indicates a smooth contour of the joint on the right. On palpation, pain is noted, more on the outer surface. On palpation of the patella, crepitus is noted, displacement to the sides causes pain. Range of motion in the joint: 180 ° extension with a vertical position of the body, flexion to 95 °. On the x-ray there were changes corresponding to stage II of osteoarthrosis with the transition to stage III. 08/19/10 blood sampling was performed in a volume of 450.0 ml from a cubital vein into a special disposable plastic bag hemacon with a capacity of 450 ml, containing 63 ml of an anticoagulant based on citrate. The platelet count in which amounted to 194 thousand / ál. Blood was centrifuged on a PC rotary centrifuge for 6-7 minutes at 2500 rpm. The autoplasma obtained in the supernatant was subjected to second centrifugation for 30 min at 3000 rpm. After that, platelet-poor autoplasma was removed and 20 ml of platelet-rich autoplasma was removed. The platelet count in the resulting autoplasma was 2677 thousand / μl. The resulting erythrocyte mass was returned to the bloodstream. The resulting platelet-rich autoplasma was mixed with a 0.25% CaCl ₂ solution in a 3: 1 ratio. 2 hours after blood sampling by external access, after local anesthesia of the skin, a right knee joint was punctured and 15 ml of platelet-rich autoplasma activated with 0.25% CaCl ₂ solution were injected. The remaining 5.0 ml of platelet-rich autoplasma was injected into the paraarticular tissue along the outer surface of the knee joint at the point of greatest pain. 08/26/2010 the procedure is repeated. After the procedures, the patient was forbidden axial load on the limb with walking on crutches for 3 days. There were no complications during the procedure. 10 days after the treatment, the patient's condition and joint function improved significantly. The pain in the joint has completely stopped. With an objective examination of the edema, there is no pain during palpation, flexion in the right knee joint 75 °. Discharged in satisfactory condition. Examined after 4 and 12 months, no complaints, works at the previous job.

The positive effect of the treatment is explained by the fact that the introduction of platelet-rich autoplasma into the joint cavity improves the sliding of the articular surfaces and reduces the mechanical damage to the articular cartilage during functional loading. Platelet-rich autoplasma plays an important role in cartilage regeneration by regulatory cells, protein synthesis, and growth factors. It stimulates mesenchymal cells, which contributes to the proliferation of chondrocytes. Growth factors released from platelets induce joint tissues to secrete hyaluronic acid, which contributes to the creation of a homeostatic environment for tissue repair within the joint and paraarticular formations. The advantage of platelet-rich autoplasma is that it contains a significantly larger number of platelets, and hence growth factors. It is autologous, pyrogen-free and non-toxic, which creates an ideal basis for cell incubation. There is no danger of introducing hepatitis virus, HIV and other infections. The method is simple, does not require expensive equipment and special training of medical personnel and can be used in the treatment of osteoarthritis.

The described method for the treatment of osteoarthrosis was used in 19 patients. In all patients, it was possible to achieve relief of pain from 7 to 18 months, as well as an increase in range of motion in the affected joint. There were no complications using this technique.

Claims (1)

A method of treating osteoarthritis of the knee joint by acting on the affected joint, characterized in that an autoplasma rich in platelets, containing from 725 to 3029 thousand / μl of platelets (normal from 162 to 358 thousand / μl) and activated with a 0.25% solution of CaCl ₂ in a ratio of 3: 1, in the amount of 10-15 ml, 2 times per treatment course with an interval of 5-7 days.