RU2468839C2 - Method of treating inflammatory-degenerative arthropathies - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely traumatology, orthopaedics and rehabilitation, and may be used for treating inflammatory-degenerative arthropathies. The therapy is three-staged. The first stage involves at least one course of the integrated therapy aiming at inflammatory response suppression and pain syndrome arrest. The second stage involves at least one session of focused extracorporeal shock wave therapy to create microcavities buried in a interarticular cartilage. At the third stage, the created microcavities buried in the interarticular cartilage are filled with a modelling compound by interarticular electrophoresis followed by stabilising the modelling compound. The modelling compound is represented by a mixture of 15 portions of fine biopolymer gel, 65 portions of hyaluronic acid, 15 portions of animal's articular cartilage extracts and 5 portions of Dimexidum solution. The modelling compound is stabilised by non-invasive exposure to pulse high-power IR laser at wave length 785 nm and heated to 44 Celsius degree.

EFFECT: method provides high clinical effectiveness to be implemented in outpatient care that enables avoiding a surgical intervention, including joint replacement, and ensuring complete removal ensured by possibility of recovery of shape, volume and normal consistence of the interarticular cartilage.

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Description

The invention relates to medicine, namely to traumatology, orthopedics and rehabilitation, and can be recommended for the treatment of arthrosis, arthritis of various etiologies and traumatic lesions of the menisci and muscular-ligamentous apparatus of the joints.

A number of pathologies are encountered in orthopedic and traumatological practice, the therapeutic treatment of which is ineffective. Such diseases include chronic polyarthritis, deforming arthrosis of the 2nd to 3rd stage, meniscus injuries, etc.

Currently, the prior art methods for treating such pathologies, both surgical and non-surgical methods.

So, from the description of the patent of the Russian Federation No. 2114649 (IPC 6 A61N 1/30, published July 10, 1998), a method for treating joint diseases by electrophoresis of an aqueous mud extract is known, which is used as a suspension of finely ground schungite rock in water.

The disadvantage of this method is its low efficiency.

Also known is a method of treating deforming arthrosis of the knee joint with aseptic necrosis or post-traumatic deformation of the tibial condyles, including articulated submandibular osteotomy of the tibia with correction of the axis of the limb, plasty of the articular surface of the tibia, bone-cartilaginous autograft and transplanted autotranslate orotranslate orotranslate orthotransplantate orthotopic a bone-cartilage demineralized graft is placed on top of a bone autograft so that the articular surface is fully restored (RF patent No. 2241396, IPC 7 A61B 17/56, published December 10, 2004).

The main disadvantage of this method is surgery and a long restoration of the joint (from six months). At the same time, for some patients it is not always possible to recommend surgical treatment or joint replacement (for example, in the case of multiple joint damage or in the presence of contraindications for surgery).

In addition, there is a method of treating articular complications of rheumatic diseases, in which a solution of solcoseryl or actovegin is injected into the joint cavity and into the affected bone in the direction of the aseptic necrosis zone (RF patent No. 2205609, IPC 7 A61B 17/56, published June 10, 2003).

The disadvantage of the above method is to eliminate only the consequences of the disease, and not its cause, which leads to the need for a course of treatment at least once a year.

A patented method for treating inflammatory and degenerative joint pathologies by the method of intraarticular modeling of cartilage tissue is an alternative to therapeutic and surgical treatment.

The technical result achieved by applying the patented method is the high efficiency of therapy, which allows to achieve complete cure, the ability to avoid surgical intervention, including joint replacement, the possibility of outpatient treatment, the absence of contraindications.

The claimed technical result is achieved by implementing a method of treating inflammatory and degenerative joint pathologies, which consists in the fact that the treatment is carried out in three stages, the first of which carries out at least one course of complex therapy aimed at suppressing the inflammatory reaction and relieving the pain syndrome, at the second stage, at least one session of focused extracorporeal shock wave therapy of ultrahigh power is used, aimed at creating microcavities in the thickness of the cartilage, which At the third stage, they are filled with a modeling composition, which is used as a mixture of 15 parts of a finely dispersed biopolymer gel, 65 parts of hyaluronic acid, 15 parts of an extract from articular cartilage of animals and 5 parts of Dimexidum solution, and filling the micro cavities is carried out by the method of intraarticular electrophoresis followed by stabilization of the modeling composition using non-invasive exposure to a pulsed high-energy infrared laser with a wavelength of 785 nm while providing heating for the filling mode iruyuschego composition to 44 degrees Celsius.

The main difference between the patented method of treating inflammatory and degenerative joint pathologies from other known methods is the creation of microcavities in the thickness of the intraarticular cartilage with the subsequent filling of the formed cells with the modeling composition and stabilization of the resulting structure, which allows for complete restoration of the shape, volume and normal consistency of the articular cartilage

Complex therapy at the first stage of treatment includes microwave heating of the musculo-ligamentous apparatus of the affected joint, ultrasound therapy and anti-inflammatory drug therapy.

Microwave (microwave) heating of the musculo-ligamentous apparatus of the affected joint is electromagnetic radiation between radio waves and infrared, i.e. at a wavelength between 1 m and 1 cm at a frequency of 300 MHz to 30 GHz. In medicine, three frequencies are used and, accordingly, three lengths of microwaves: 2450 MHz (12.245 cm), 915 MHz (32.79 cm) and 433.9 MHz (69.14 cm). In Europe, all three frequencies of microwave therapy are used; in the USA, only the first two.

To obtain the microwave electromagnetic field, a magnetron vacuum device is used, combining the functions of an electronic lamp and an oscillating circuit.

The electron source in the magnetron is the cathode. The electric field between the cathode and the anode accelerates the movement of electrons. The small permanent magnet that the magnetron is equipped with creates a magnetic field directing the movement of electrons. The microwave electromagnetic field is supplied to the tissues using special directional emitters, which are dielectric antennas. Emitters are used by contact and remote exposure techniques. During remote exposure, the device is installed in a shielded cab so that the emitter is directed towards the outer wall.

The energy of microwaves is absorbed mainly by water molecules, their dielectric constant is therefore low. Under the influence of microwaves of the centimeter range (SMB therapy), water dipoles have time to turn completely in one polarity reversal. The absorption of their energy occurs primarily in tissues rich in water. A significant degree of reflection by their surface of the skin, which is not possible to take into account when dosing the procedure. Depending on the thickness of the subcutaneous fat layer and the particular arrangement of the emitter, 25 to 75% of the microwave energy is reflected, on average about 40%. They are significantly reflected from the interfaces of other tissues: skin - subcutaneous tissue, subcutaneous tissue - muscles. In this case, the formation of so-called "standing" waves in the tissues is possible. They are formed when the wave is reflected from the boundary of two media and superimposed reflected on the next incident wave. Such a process occurs many times in the same place. According to the laws of physics, a "standing" wave is formed if the distance between the boundaries of the two media is more than a quarter of the wavelength. This situation can occur when the thickness of the subcutaneous fat layer is more than 2 cm.

Decimeter-wave microwaves (UHF therapy) are approximately twice less intensely reflected by the skin surface. They are absorbed by water to a lesser extent than waves of the centimeter range, since the resonance phenomena of water dipoles at this frequency of the electromagnetic field are less pronounced. The energy of these waves, as they penetrate into the depths of the tissues, attenuates two times slower compared to centimeter waves.

Tissue warming up during SMB therapy occurs to a depth of 3 cm. With the formation of "standing" waves, a significant local increase in tissue temperature occurs up to a burn. This overheating of the tissue is accompanied by a feeling of fullness, burning, breaking pain, which requires an immediate reduction in the dose of exposure or termination of the procedure. Uncontrolled overheating can occur when exposed to sharply edematous tissue.

In UHF therapy, tissue heating occurs to a greater depth, amounting to 8-10 cm. The probability of the formation of "standing" waves is negligible and tissue heating is more uniform.

The physiological effect of the effects of microwave therapy on a living organism is an increase in the metabolic activity of all cells, a decrease in viscosity in all fluids, an increase in the extensibility of collagen, an increase in blood flow, and an effective effect on the nervous system.

The therapeutic effect of the action of microwave radiation manifests itself as an anesthetic (due to the direct effect on the pain gate, accelerated removal of irritating factors and due to increased blood flow, decreased muscle spasm, sedative effect), decreased or complete cessation of muscle spasm due to the direct effect on spindle-shaped muscle structures, acceleration recovery due to increased metabolic activity, which affects the post-traumatic process and the course of chronic Skog infectious process, softening of collagen tissue and other scar tissue fibrosis, the treatment of muscle tissue due to increased blood flow intramuscular.

The anti-inflammatory effect of microwaves, anti-allergic effect, and a positive effect on immunogenesis are associated with the oscillatory effect. Despite the fact that the effect of microwaves spreads to a small volume of tissues, general reactions can be observed. They are realized mainly through an increase in the function of the parasympathetic department of the autonomic nervous system: lowering blood pressure, decreasing the number of heart contractions, and slowing down intraventricular conduction in the heart. There is a stimulation of the synthesis of some prostaglandins.

The antispastic analgesic effect, the intensification of blood and lymph circulation in tissues, and the intensification of metabolism are associated with the thermal effect of microwaves. It should be remembered that the oscillatory and thermal effects are inseparable and occur simultaneously.

Ultrasonic radiation is a type of mechanical energy and represents mechanical vibrations of an elastic medium with a frequency of more than 16 kHz, which are not perceived by the human ear. These vibrations are transmitted in the form of longitudinal waves, which cause alternating compression and rarefaction of the medium or substance. The greater the power of the transmitted energy, the greater the amplitude of the deviations of the particles of the medium from the initial state. The distance, which includes one compression region and one rarefaction region, is the wavelength, which will be inversely proportional to the oscillation frequency. Ultrasonic low-frequency waves propagate spherically. As the oscillation frequency increases and, accordingly, the wavelength decreases, the beam of ultrasonic waves becomes more rectilinear. The straightness of the propagation of high-frequency ultrasonic waves (800-3000 kHz) determines their use in physiotherapy. These waves propagate parallel to each other, they can be concentrated in a limited area.

The absorption of ultrasonic waves in different tissues is different. For example, the absorption coefficient of ultrasound for bone tissue is 12-15 times higher compared to muscle tissue. In general, the higher the oscillation frequency, the more intense the absorption, the less the penetration depth. High frequency ultrasound is intensely absorbed by air. The smallest layers between the emitter and the surface of the skin trap ultrasonic waves. In this regard, during the treatment, airless contact media are used: paraffin oil, glycerin, lanolin. In those cases when tight contact is impossible between the ultrasound transducer and the skin surface (area of the brush, foot), remote exposure is performed through water with a gap of 1-2 cm. To obtain ultrasound, the inverse piezoelectric effect is used.

Under the piezoelectric effect is understood the phenomenon of electrical polarization of crystals caused by their mechanical deformation: compression, tension, bending, torsion. Crystals of quartz, barium titanate, Rochelle salt and others possess such properties. On the other hand, when these crystals are placed in an alternating electric field, they are compressed and stretched depending on the direction of the field. The frequency of the obtained mechanical vibrations corresponds to the frequency of the electric field. Thus, the apparatus for producing ultrasound consists of a high-frequency generator and an ultrasonic emitter (vibrator, applicator), in which a plate of quartz or barium titanate is placed.

The ultrasonic emitter is pressed tightly against the surface of the skin in the area of the affected joint or, if tight contact is not possible, then remote exposure is carried out through water. The remote method is used in cases where the processed surface of the body has a complex shape (fingers and toes) or a large surface (more than 30 cm ² ). To this end, in a glass or ceramic cuvette filled with water or a medicinal solution, a whole body section is placed, which they intend to expose to ultrasonic radiation. Then an ultrasound source (emitting head) is immersed in water and the ultrasonic wave generator is turned on.

The main biophysical processes in tissues are associated with three main effects of ultrasound: mechanical (mechanical-dynamic), physico-chemical and thermal.

The mechanical effect is manifested at the cellular and subcellular levels. Ultrasound exposure to high intensity leads to tissue rupture with the formation of microscopic cavities, the lifetime of which is comparable with the period of ultrasonic vibrations. The mechanical action of low-intensity ultrasound used in physiotherapy consists in vibrational micromassage of tissues. At the same time, the processes of diffusion and osmosis are intensified in cells and tissue structures.

The physicochemical activity of ultrasound is associated with complex electron-quantum phenomena at the molecular level. The movement of molecules is accelerated, the formation of ions is enhanced. The amount of free radicals in tissues increases, the formation of biologically active substances and redox reactions are activated, and the dispersion of cell colloids increases. At therapeutic doses, ultrasound is a catalyst for biochemical reactions.

The thermal effect is associated with the conversion of mechanical energy into heat, that is, we are talking about endogenous heat. Heat is released primarily in tissues that intensively absorb ultrasound: nerve tissue, bones. The entire tissue is heated - volumetric heating, heat is also released at the boundary of two media of different acoustic density - structural heating. Since small intensities of ultrasound are used in physiotherapy, a marked increase in tissue temperature during the procedure is not observed. The thermal effect in this case plays a secondary role.

Depending on the dose used, the damaging, inhibitory and stimulating effect of ultrasound can be observed. In physiotherapy, doses are used that cause a stimulating effect, do not cause destructive changes in the tissues. To determine the optimal frequency, radiation power and duration of the procedures, standard tables are used for physiotherapeutic ultrasound treatment, where the radiation dose depends on the depth and surface area of the pathological focus. The deeper the focus is located and the larger it is in size, the greater the frequency, power and radiation time should be used.

The depth of penetration into ultrasound tissues with a frequency of 800-1000 kHz is estimated at 5-6 cm, with a frequency of 2400 kHz - three times less. Best of all, ultrasound penetrates adipose tissue, is delayed by muscle and nervous. A significant amount of ultrasound is absorbed at the interface between tissues with different acoustic densities. From bones, up to 60% of the ultrasound energy incident on them is reflected. In small subthreshold doses, ultrasound can penetrate to a depth of 20 cm, as evidenced by the visualization data of waves reflected from this depth. This fact is used in ultrasound diagnostics.

Physiological responses associated with major biophysical effects are closely intertwined and interact. At therapeutic doses, ultrasound generally has a stimulating effect on cell function. In the initial phase of exposure, mitochondria swell, deviations in the matrix structure are observed, the structure of the cellular form becomes blurred. Irritation of the cell leads to the activation of its vital activity, increased respiratory activity of mitochondria. In general, the effect of biological stimulation is observed, which lasts for several hours after a single exposure. Higher doses cause sharp changes in cellular microstructures, inhibit cell activity, and signs of a damaging effect appear.

When ultrasound affects the connective tissue, rejuvenation of its cellular and fibrous structures is observed. Cells with abundant protoplasm appear, the amount of elastic fibers in the main substance increases and collagen formation is inhibited. When exposed to excess connective tissue with a changed structure, ultrasound exerts a tearing effect, which makes the scar more elastic.

Low-intensity ultrasound accelerates the regeneration of damaged nerve fiber, reduces the sensitivity of receptors, which is manifested by anesthetic effect. Ultrasound acts on the receptor apparatus of the skin without causing noticeable subjective sensations. The skin of the face and abdomen is most sensitive to its effects. The impact on the skin receptors of certain reflexogenic zones leads to general responses that are realized through the higher vegetative centers, the hypothalamic-pituitary system. According to this mechanism of action, ultrasound therapy increases the lability of the nerve centers and the adaptive-trophic functions of the whole organism. Some treatments use this common action of ultrasound.

Anti-inflammatory therapy consists in prescribing a course of non-steroidal anti-inflammatory drugs (Voltaren 75 mg × 3 ml) in the form of intramuscular injections of 1 ampoule 3 times a week, but not more than 10 ampoules for the entire course of treatment.

The success of the first stage of treatment is determined by the results of repeated ultrasound images of the affected joint, which determine the dynamics of changes in the severity of soft tissue edema. In some cases, magnetic resonance imaging (MRI) may be needed during the procedure.

At the second stage of treatment, at least one course of complex therapy is used, aimed at creating microcavities in the thickness of the cartilage, which will subsequently be filled with a modeling composition. A similar effect is achieved by using focused extracorporeal shockwave therapy of ultrahigh power.

Focused extracorporeal shock wave therapy of ultrahigh power (F-SWT method) is based on a short-term (0.5 second) application of a high-energy focused low-frequency shock sound wave to the disease area, which loosens calcium deposits and fibrous lesions, which cause inflammation and pain, and also forms microfractures in areas of cartilage that are weakened by degeneration.

By the amount of emitted energy, it is customary to subdivide shock wave therapy (UHT) into low-energy (up to 1-2 MPa, used mainly for physiotherapeutic procedures), medium-energy (up to 3-5 MPa, used to treat the musculo-ligamentous apparatus), high-energy ( up to 10-15 MPa, is used to treat protrusions and hernias of the intervertebral discs) and ultrahigh power (from 15 MPa and above, is used to destroy stones in the kidneys and gall bladder, as well as in the described method of treating joints).

F-SWT is based on creating a shock wave with a high flux density, which focuses on a limited target area. This should ensure that shock waves develop full energy exclusively in the area selected for therapy without causing damage to the surrounding tissues of the body. The hyperbaric effect of F-SWT is based on the ability of acoustic vibration to form microcavities in tissues as a result of the transition of a liquid into a gas and its exit. This component of F-SWT therapy is critical in the treatment of rapidly degenerative joint diseases. Thus, the effects produced on the tissue lead to deformation of cell membranes as a result of the mechanical action of shock waves.

The parameters that determine the success of extracorporeal therapy are mainly energy and energy flux density. These parameters depend on the degree of degeneration of the articular cartilage and are selected individually for each patient. The mechanical or acoustic energy of a shock wave is determined by the pressure amplitude and its duration, the acoustic properties of the medium (density and acoustic velocity) and the spatial propagation of the shock wave. In order to achieve a noticeable effect in the tissues, the energy of the shock wave should be concentrated on a precisely limited target area, where it will exceed the threshold values and produce a therapeutic effect. It is believed that shock waves are effective if the pressure reaches 200 bar (20 MPa) or more. This zone corresponds to the so-called 20 MPa focus.

Extracorporeal shock wave therapy is carried out at a threshold energy value selected from the range of 15-25 MPa. In this case, it is generally accepted that the selected course of focused extracorporeal shock wave therapy is considered optimal when 10-15% of the mass of the articular cartilage is formed in one microcavity session, which can be monitored by ultrasound of the joint. The energy flux density is set by the device settings during the F-SWT session, and the pulse frequency (from 0.5 to 20 Hz) is determined by the doctor depending on the dynamics of the effectiveness of the therapy. If the patient begins to experience painful sensations even with a properly focused shock wave flow, it is necessary to reduce their energy by 2.0-5.0 MPa. You can also lower the pulse frequency by 1-5 Hz. As practice shows, in most cases this is quite sufficient with a relatively small decrease in the effectiveness of therapy. To achieve the maximum effect of wave penetration into body tissues, it is desirable to use gel conductors, for example, conductive gel for ultrasound therapy / diagnostics. At the same time, the F-SWT emitter head is pressed firmly against the joint surface, slowly moving so that the radiation focus always remains concentrated in the area of the affected cartilage.

As mentioned above, the F-SWT course consists of a significant number of sessions. From 3 to 20 procedures may be required to create the right amount of microcavities in the cartilage tissue. It is absolutely necessary to perform control ultrasound images of the joint undergoing treatment every 5-6 sessions to control the process of cartilage loosening.

The completion of the second stage should also be accompanied by a magnetic resonance imaging (MRI) scan.

The third stage of treatment is used to fill the formed microcavities in the thickness of the inter-articular cartilage with a modeling compound using the method of intraarticular (interstitial) drug electrophoresis and stabilization of the obtained cells with a laser.

Electrophoresis of medicinal substances (drug electrophoresis) - the movement of particles and molecules suspended in a liquid in an electric field. In physiotherapy, this is a method of introducing drugs into the body through a constant electric current through the skin or mucous membranes. In this case, there is a combined effect of direct electric current and a drug substance, in connection with which this method is referred to as an electropharmacological treatment method.

Medicinal iontophoresis is based on a combination of the physiological effects of galvanic current in combination with drugs. In general, this mechanism can be represented as follows: pain gates produce an effect on the A-delta (fast) and C (slow) pain fibers in the posterior horns of the spinal cord as a result of stimulation of mechanoreceptors (A-beta) of fibers with high-frequency low-intensity electric current and in combination with the selected drugs produce a morphine-like effect on the C-fibers of the system for the production of encephalin by nerve stimulation of the A-delta fibers of pain receptors, as a result of which the ion balance around the cells changes, accelerates after the healing of skin wounds and bones, fibrous tissue is restored, cell metabolism is increased and the potential of cell membranes is restored, microcirculation increases.

Drug electrophoresis does not boil down to a simple summation of the effects of galvanic current and drug substance. As a result of their interaction, the influence of each of these factors is enhanced, as a result of which a qualitatively new effect is observed. The response depends primarily on the pharmacological properties of the drug substance. With superficially located pathological processes by electrophoresis, it is possible to create a sufficiently high concentration of the drug directly in the lesion, without saturating the body.

The method of drug electrophoresis has a number of features and advantages compared with other methods of drug administration: 1) it makes it possible to create the highest and most uniform concentration of the drug in the pathological focus, to carry out local exposure; 2) drugs introduced by this method are less likely to cause adverse reactions compared with those administered enterally and parenterally; 3) the treatment method is painless, does not cause deformation of the skin and soft tissues, there is no irritation of the mucous membrane of the gastrointestinal tract; 4) ions or individual ingredients of medicinal substances are introduced, the therapeutic effect of which is expected; 5) drugs in ionic form show their maximum activity; 6) drugs act on the background of tissue changes caused by galvanic current. Under these conditions, their effect is more pronounced, manifests itself at concentrations that are not very effective with other methods of administration.

Some medicinal substances are electrically neutral, have low electrophoretic mobility, lose their activity under the influence of electric current. Substances having a complex and diverse ionic composition are administered bipolar. Medicinal substances insoluble in water and alcohol are introduced into DMSO (dimethyl sulfoxide, dimexide), which is a universal solvent. Buffer solutions are used for electrophoresis of enzymes (lidase, ronidase, trypsin, chymotrypsin).

In the patented method for treating inflammatory and degenerative joint pathologies by the method of intraarticular modeling of cartilage, the drug composition is injected directly into the intraarticular gap, and four electrodes of a conductive polymer 4 × 4 cm in size are fixed on the joint surface, to which a bipolar modulated current is applied in alternating vector mode (40 volts 60 mA 100 Hz) - this allows you to evenly distribute the drug throughout the mass of cartilage. The duration of the procedure, depending on patient tolerance, is 15-20 minutes.

The modeling composition is necessary to fill the microcavities obtained in the second stage in the tissues of the inter-articular cartilage, thus creating cells that, after stabilization, take on the function of damaged chondrocytes. Due to the fact that the volume of the microcell filled with the composition exceeds the volume of the empty microcavity, after the modeling procedure is completed, the cartilage increases in volume to 70-75%, however, in the patented method of treating joints, the cartilage thickness is increased by no more than 50-60%, otherwise it can the structural integrity of the cartilage is affected due to the pronounced heterogeneity of the tissue.

As a modeling composition, a mixture of 15 parts of a finely dispersed biopolymer gel, 65 parts of hyaluronic acid (in the form of preparations based on it: Osteonil, Fermatron, Sinvisk, Dyuralan), 15 parts of an extract from articular cartilage of animals (in the form of preparations based on it) is used: Discus compozitum, Rumalon) and 5 parts of Dimexidum solution. The obtained sterile composition is injected directly into the intraarticular cleft, from which it is further redistributed uniformly into the thickness of the inter-articular cartilage by electrophoresis on the affected joint, filling it with microcavities.

In total, depending on the size of the joint and the amount of work, it is necessary to administer from 3 ml of the composition once in one procedure in case of uncomplicated arthritis to an 8-10-fold administration of 3 ml of the composition in case of arthrosis of the 3rd degree.

After the modeling composition saturates the cartilage and fills the microcavities, which is determined by the ultrasound images of the joint, the composition is stabilized using a high-intensity infrared laser with a wavelength of 785 nm.

Laser Therapy The bio-stimulating effect of laser radiation in the red and infrared ranges is based on the processes of active capture of light quanta by molecules - photosensitizers, which transport energy to negative forms of molecules, followed by breaking of ionic bonds in them and the formation of freely charged ions. At the same time, there is an increase in the permeability of cell membranes for these ions and enzymes, as a result of which the bioenergetic activity of cells in protein, nucleic and lipid metabolism increases. When laser radiation is absorbed, it is completely converted into thermal energy. As a result, there is a thermal expansion of the cytoplasm, activation of various enzyme systems and, possibly, a change in the viscoelastic properties of the membranes, which serve as natural phase boundaries in biological space. These changes at the molecular level can be an impetus for deeper secondary effects.

The infrared rays absorbed by the tissues are completely converted into thermal energy of vibration of the molecules. Thermal expansion of the protoplasm of cells can cause hydrodynamic effects, which become the initial impulse of the general action of an infrared laser. Even a short-term increase in temperature fluctuations in critical sections of a molecule will lead to its transfer to a new conformational state with a different reactivity. Photoactivation in a complex biological object, such as the human body, occurs as a multi-stage process.

In the human body, in addition to specialized photoreceptors, there are a lot of photoreceptors with universal properties. These include hemoglobin, which has various absorption bands depending on the state in the oxy or deoxy form: porphyrins, cyclic nucleotides, iron and copper-containing enzymes (catalase, superoxide dismutase), redox enzymes, cytochromes, pigments and other substances. The intensity of laser radiation exposure is determined both by the nature of the radiation itself (wavelength, density of radiated power, exposure, modulation in frequency and amplitude, etc.), and the properties of biosystems.

The depth of penetration of a laser beam into a biological object depends on the wavelength, radiation, and exposure technique (contact, distant). The penetrating power of radiation gradually increases from the ultraviolet to the orange spectral region.

The nature of the action of laser radiation on a biological object largely depends on the length and power of the laser. When laser radiation acts on bone tissue, bone tissue regeneration is activated in the form of accelerated proliferation of osteoblasts and osteoclasts while enhancing cell differentiation; accelerating the process of bone marrow remodeling, increasing the content of calcium, phosphorus and protein in the bone, increasing the volume of bone, vascularization of bone tissue. Under the influence of low-intensity laser radiation on articular cartilage, the anti-inflammatory effect of laser radiation, an increase in fibrinogen level, and fibroblast proliferation are observed. The positive effect of laser therapy for deforming arthrosis and arthritis was expressed in the elimination or reduction of pain, normalization or increase in range of motion in the affected joint, the disappearance of stiffness and easier walking.

Laser radiation stimulates the division of isolated muscle cells. The basis of this effect is the property of this radiation to enhance anti-apoptotic processes, which indicates the protective role of laser radiation in the activation of tissue regeneration. The effect of laser radiation on dystrophic changes in the skeletal muscle is manifested in an antiparabiotic effect (removing the focus of alteration from the exaltation stage of parabiosis), improving metabolism and oxygen transfer in the muscle due to vascularization of muscle tissue, and increasing the volume of mitochondria responsible for energy processes.

All laser therapy methods used to treat patients with an orthopedic and traumatological profile can be divided into two large groups - invasive laser therapy (performed with violation of tissue integrity) and non-invasive (without violation of tissue integrity). The most commonly used external (percutaneous) laser therapy. Irradiation is carried out in fields, zones, acupuncture points. Variants of a stable (motionless) and labile (scanning with a laser beam) technique are used. Irradiation can be carried out with a focused and defocused laser beam through air or through a liquid medium. In addition, one can distinguish distant (with a certain gap between the skin and the emitter) and contact (without a gap) effect.

Upon contact exposure, laser radiation is applied directly to the skin using a fiber or a radiating head without a gap between them. Distinguish between contact, contact with compression (dosed pressure on the skin with the end of the fiber or the radiating head) and contact-mirror effect (a reflecting mirror is placed on the sides of the fiber). To enhance the absorption of laser radiation (in pathologically altered tissues), some dyes can be used, since in the colored areas the absorption of laser energy in the red range increases to 60-70%, which, of course, enhances the therapeutic effect.

The methods of invasive laser therapy used in orthopedics and traumatology include

- intravascular laser blood irradiation (VLOK); laser puncture (invasive) - deep laser stimulation of acupuncture points (TA) through a hollow needle into which a fiber is inserted;

- interstitial laser therapy (intraosseous, periosteal, myofascial, intraarticular).

One of the options for laser therapy is intravascular laser blood irradiation (VLOK), which currently has found very wide practical application. The therapeutic effect of laser radiation in this case is based on the interaction of coherent monochromatic radiation with blood structures, primarily cellular elements, as well as the effect on hemoglobin and its conversion to a more “conformational” state for oxygen transport.

Indication for intraosseous laser therapy is a pronounced tenderness of bone structures. The indication for periosteal laser therapy is a moderately and slightly pronounced tenderness of bone structures. Intraosseous and periosteal laser therapy can be supplemented with myofascial laser stimulation. To affect bone structures, intraosseous puncture is performed (depth 0.3-1 cm), myofascial compaction - intramuscular puncture (depth 4-5 cm), periosteal puncture the periosteum (depth 0.1-0.2 cm), during intraarticular RT produce joint puncture.

In the patented method for the treatment of inflammatory and degenerative joint pathologies by the method of intraarticular modeling of cartilage, to stabilize the modeling composition in cartilage microcells, pulsed non-invasive irradiation with a high-energy infrared laser with a wavelength of 785 nm and a radiation power of 7-10 W with a pulse duration of 0.5 seconds and a pulse frequency is used 1 Hz

The purpose of this manipulation is to heat the modeling composition filling the microcells to 44 degrees Celsius. At this temperature, microscopic drops of finely dispersed biopolymer gel merge into large vacuoles inside the microcell. After cooling the modeling composition to a temperature of 37-38 degrees Celsius normal for a person inside the joint, each micro-cell is filled with a modeling composition that is reliably held inside the cartilage by droplets of biopolymer gel.

During manipulation, it is necessary to carefully monitor the temperature of the cartilage, as measured by an infrared thermometer. If cartilage tissue is heated too quickly, it is necessary to either reduce the radiation power by 1-2 W, or increase the interval between pulses by 1-2 Hz, or reduce the pulse duration by 0.2-0.3 seconds.

After each manipulation, it is necessary to control the result using ultrasound images of the joint.

The described method for the treatment of inflammatory and degenerative joint pathologies by the method of intraarticular modeling of cartilage tissue is extremely effective even in the third stage of arthrosis, when any other methods of conservative treatment are unsuccessful. At the same time, this method avoids surgery to replace the joint, which until recently was considered the only method of treatment for severe degeneration of intraarticular cartilage.

According to statistics obtained by the Israeli clinic "Pain Clinic Unique methods of medical treatment" according to the results of 13 years of experience in managing more than 14,000 patients with various joint pathologies, the effectiveness of treatment with the method of intraarticular modeling of cartilage tissue approaches a 95% clinically and laboratory confirmed positive result.

As an illustration of the given material, we can consider several cases of successful application of the method of treating inflammatory and degenerative joint pathologies by the method of intraarticular modeling of cartilage tissue using the patients of the International Medical Center for the Treatment of Especially Serious Musculoskeletal System Pathologies (MMC ODA) and the Zarya Medical Center "At the federal state unitary enterprise" GKNPTs im. M.V. Khrunicheva "

Patient B-in, 45 years old, complaints: over the past few months, severe pains have developed in the right knee joint, aggravated by walking and physical exertion. Cannot go more than 100 meters without stopping. Pain is given to the right leg. Anamnesis of the disease: considers himself ill for more than 5 years, was treated with physiotherapy and NSAIDs with a short positive effect. According to the results of the examination in CITO, the operation to replace the right knee joint is recommended

Joints: on examination, the right knee joint is strongly edematous and moderately hyperemic. On palpation, severe pain. The range of active movements in the joint is limited.

Ultrasound of the right knee joint: in the area of the medial edge of the patella, bone-deforming growths are visualized. The synovial membrane is thickened to 1 mm. The contour of the medial condyle of the femur is uneven, deformed. The tibial contour is uneven, thickened, osteophytes up to 3 mm are located on the entire surface. The joint gap is narrowed. Hyaline cartilage significantly thinned to 1.1 mm, heterogeneous.

Conclusion - gonarthrosis of the right knee joint 3 degrees with signs of inflammation.

The treatment was carried out in accordance with the patented method.

At the first stage, a course of anti-inflammatory therapy was prescribed, consisting of 5 sessions of ultrahigh-frequency heating of the right knee joint, 5 sessions of ultrasound on the right knee joint and 5 intramuscular injections of Voltaren 75 mg each. After the first stage, according to the results of ultrasound, a decrease in the inflammatory process of the soft tissues of the joint was observed.

Next, a course of focused extracorporeal shock wave therapy was conducted. The course included 15 sessions. On a second ultrasound performed in the same medical institution: in the tissue of the intraarticular cartilage, multiple echo-signs of rarefaction of the tissue, indicating the occurrence of microcavities.

At the third stage of treatment, 5 intraarticular injections of a modeling composition of 3 ml each were performed, followed by intraarticular drug electrophoresis and pulsed non-invasive irradiation with a high-energy infrared laser.

Each of the injections of the modeling composition contained a mixture of 15 parts of a finely dispersed biopolymer gel, 65 parts of a solution of 2% hyaluronic acid, 15 parts of an extract from articular cartilage of animals and 5 parts of Dimexidum solution.

On the control ultrasound: when compared with the previous ultrasound examination, positive dynamics are noted, the patella contour is clear, even. Own ligament of the patella is not structurally changed. Soft tissue in the patella region is homogeneous. In the suprapatellar sac, fluid contents are not detected. The synovial membrane is not thickened. The condyles of the femur and tibia are distinct and even. Menisci are homogeneous. Joint gap of normal size. Hyaline cartilage of normal sizes up to 2 mm.

Conclusion - Ultrasound signs of pathology of the right knee joint are not determined.

After the course of treatment, the patient's condition is excellent, there are no pains, the normal range of motion in the affected joints has been restored.

Epicrisis: the patient was discharged completely cured, no complaints, signs of arthrosis are not detected, it is recommended to limit physical activity for two months.

The patient was examined three years after undergoing treatment, no complaints, leads an active lifestyle, plays sports. An MRI scan was performed that did not reveal any joint pathologies.

Patient D., 37 years old, complaints: over the past few months, she has noted severe pain in the left foot, aggravated by walking and physical exertion. She was treated with Voltaren with temporary relief. Joints: on examination, the left foot is swollen. On palpation, severe pain.

On the MRI of the left foot, unevenness of the cortical bone layer, osteophytes 1.3-1.5 mm, hyaline cartilage uneven in thickness, muscle tendons are heterogeneous in structure.

The diagnosis is deforming arthrosis of the joints of the left foot of the 2nd degree.

The treatment was carried out in accordance with the patented method.

At the first stage, a course of anti-inflammatory therapy was prescribed, consisting of 3 sessions of ultra-high-frequency heating of the right knee joint, 3 sessions of ultrasound on the right knee joint and 3 intramuscular injections of Voltaren 75 mg each.

Next, a course of focused extracorporeal shock wave therapy was conducted. The course included 10 sessions. On repeated ultrasound: In the tissue of the articular cartilage, echo-signs of rarefaction of the tissue, indicating the occurrence of microcavities.

At the third stage of treatment, 5 intraarticular injections of a modeling composition of 3 ml each were performed, followed by intraarticular drug electrophoresis and pulsed non-invasive irradiation with a high-energy infrared laser.

Each injection of the modeling composition contained a mixture of 15 parts of a finely divided biopolymer gel, 65 parts of Osteonil, 15 parts of Discus compozitum and 5 parts of Dimexidum solution.

On the control MRI: pathology of the joints of the left foot was not detected.

Epicrisis: the patient was discharged completely cured, it is recommended to limit the load on the left leg the first two months after discharge.

The patient was examined a year and a half after undergoing treatment, no complaints. An MRI scan was performed that did not reveal any abnormalities.

The case of traumatic damage to the right ankle joint, accompanied by rupture of ligaments.

Patient G-va, 26 years old, complaints: over the past few weeks, she has noted severe pain in the right ankle joint, aggravated by walking and physical exertion. Anamnesis of the disease: considers herself sick after having twisted her leg while walking, after which there was a sharp pain in the right ankle joint, swelling of the joint and the inability to fix the foot when walking. She was treated with Voltaren with temporary relief.

Joints: on examination, the right ankle joint is sharply edematous and moderately hyperemic. On palpation, severe pain. The volume of active and passive movements in the joint is limited.

Ultrasound of the right ankle joint of the tendon of the long flexor of the big toe, the posterior tibial muscle and the underlying ligaments are heterogeneous, the fibers are intermittent. Behind the Achilles tendon, an anechogenic formation (hematoma) is visualized along it, an anechogenic formation of 13 × 5 mm (hematoma) is located on the lateral surface of the joint in the ankle area.

The diagnosis is traumatic damage to the right ankle joint, incomplete rupture of the long flexor of the big toe of the right foot, incomplete rupture of the distal part of the posterior tibial muscle.

The treatment was carried out in accordance with the patented method.

At the first stage, a course of anti-inflammatory therapy was prescribed, consisting of 5 sessions of ultra-high-frequency heating of the right knee joint, 5 sessions of ultrasound on the right knee joint and 5 intramuscular injections of Voltaren 75 mg each. After the first stage, according to the results of ultrasound, a decrease in the inflammatory process and traumatic edema of the soft tissues of the joint was observed.

Next, a course of focused extracorporeal shock wave therapy was conducted. The course included 20 sessions.

At the third stage of treatment, 8 intraarticular injections of a modeling composition of 3 ml each were performed, followed by intraarticular drug electrophoresis and pulsed non-invasive irradiation with a high-energy infrared laser.

Each injection of the modeling composition contained a mixture of 15 parts of a finely dispersed biopolymer gel, 65 parts of Sinocrom, 15 parts of Rumalon and 5 parts of Dimexidum solution.

After the course of treatment there are no pains, the range of motion in the affected joint has fully recovered.

On the control ultrasound: when compared with the previous ultrasound study, there was a positive dynamics, the musculo-ligamentous apparatus in the periarticular region of the usual echo structure, the joint space of a homogeneous hypoechoic structure, of uniform width. Reduced echogenicity of adjacent soft tissues (edema) persists.

Conclusion - ultrasonic signs of violation of the anatomical integrity of the musculo-ligamentous apparatus were not detected, there are no previously observed ultrasound signs of a hematoma.

Epicrisis: the patient was discharged with significant improvement, her condition is defined as “practically healthy”, and a recommendation is given to avoid strong physical exertion on the right ankle joint for two months.

The patient was examined a year after undergoing treatment, no complaints. An MRI scan was performed that did not reveal any abnormalities.

Claims (6)

1. A method of treating inflammatory and degenerative joint pathologies, which consists in the fact that the treatment is carried out in three stages, the first of which carries out at least one course of complex therapy aimed at suppressing the inflammatory reaction and relieving pain, in the second stage at least one session of focused extracorporeal shock wave therapy aimed at creating microcavities in the thickness of the inter-articular cartilage that are filled in the third stage with a modeling compound, which They use a mixture of 15 parts of a finely dispersed biopolymer gel, 65 parts of hyaluronic acid, 15 parts of an extract from articular cartilage of animals and 5 parts of a solution of dimexide, and the micro cavities are filled by the method of intraarticular electrophoresis followed by stabilization of the modeling composition by non-invasive exposure with a pulsed high-energy infrared laser with a length of waves of 785 nm while providing heating of the filling modeling composition to 44 degrees Celsius. 2. The method according to claim 1, which consists in the fact that the complex therapy includes microwave heating of the musculo-ligamentous apparatus of the affected joint, ultrasound therapy and anti-inflammatory drug therapy. 3. The method according to claim 2, which consists in the fact that microwave heating of the musculo-ligamentous apparatus of the affected joint is carried out with microwaves of the centimeter range or microwaves of the decimeter range. 4. The method according to claim 2, which consists in the fact that anti-inflammatory therapy consists in prescribing a course of non-steroidal anti-inflammatory drugs in the form of intramuscular injections of 1 ampoule 3 times a week. 5. The method according to claim 4, which consists in the fact that Voltaren is used as non-steroidal anti-inflammatory drugs. 6. The method according to claim 1, which consists in the fact that extracorporeal shock wave therapy is carried out at a threshold energy value selected from the range of 15-25 MPa.