RU2481130C1 - Method of treating patients suffering mandibular fractures - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely physiotherapy. A method involves exposure to magnetic field. The exposure covers projections of the cervical sympathetic ganglia. The exposure is generated by travelling pulse magnetic field having the induction of 60 mT. On the first two days, the exposure frequency is 1 Hz. On the third and fourth days, the frequency is 5 Hz. On the fifth and sixth days, the frequency is 10 Hz. The exposure length is 15 minutes.

EFFECT: method reduces the length of pain management, improves regional blood flow in the inferior alveolar arteries, reduces the number of pyoinflammatory complications, improves the repair processes at the injury through the correction of vegetative imbalance; the method reduces the manifestations of total activity of the sympathetic vegetative nervous system (VNS), promoting the VNS balance, reducing the manifestations of stress, increasing total body resistance and, as a consequence, reducing the number of complications.

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Description

The invention relates to medicine, namely to maxillofacial surgery, and can find application in the treatment of patients with autonomic changes in fractures of the lower jaw.

The traditional method of treating fractures of the lower jaw includes the following elements: reposition, fixation of fragments, immobilization of the jaws, antibiotic therapy for the prevention of purulent-inflammatory complications, various types of physiotherapy (Injuries to soft tissues and bones of the face. Manual for doctors. Ed. A. G. Shargorodsky; 2004; A. V. Lepilin. Prevention and pathogenetic treatment of purulent-infectious complications of traumatic injuries of facial bones, 1995; A. G. Shargorodsky. Prevention of odontogenic inflammatory diseases diseases, Clinical Dentistry, 1998, No. 1; Traumatology and reconstructive surgery of the maxillofacial region. Edited by Yu.I. Vernadsky, 2003; Injuries, soft tissues and bones of the face (a guide for doctors), edited by A.G. Shargorodsky . - M.: GEOTAR-MED, 2004).

In the literature, we have not found data on the severity of compensatory reactions of the victim's body, which undoubtedly arise after an injury and are realized through the autonomic nervous system (ANS). Also, no information was found on methods for correcting these violations.

Methods of exposure to the ANS today are very scarce and are based mainly on pharmacological correction. The clinical manifestation of changes in the ANS is realized through segmental apparatuses and, above all, the sympathetic system, but there are no special, specific principles for the symptomatic treatment of autonomic disorders (N.V. Menzorova. The rationale for the correction of autonomic disorders in children with cerebral palsy - Electronic scientific journal "System integration in healthcare ", No. 2 (4), 2009; A.G. Ponomareva, V.M. Medvedev, A.V. Belyaeva. Uncomfortable conditions in students and methods for their correction. Teaching aid - M.: RUDN University. 2004).

Some methods of correction of adaptive-compensatory reactions of the body are known. Their complex and multicomponent nature determines the variety of techniques and drugs used. For the prevention and treatment of the damaging effects of stress, commonly strengthening drugs are usually used - adaptogens, vitamins, mediators of metabolites of stress-limiting systems, thymus gland preparations; to mobilize the development of the general adaptive syndrome, corticotropin, corticosteroids, etc. are used (R.Yu. The use of biologically active drugs in the prevention of complications in the treatment of patients with open traumatic fractures of the lower jaw. ia. - 2008. - No. 4).

The high cost of drugs, an increase in cases of allergic manifestations on pharmacological substances, the presence of side effects of drugs force us to seek and develop alternative methods of treating patients.

For the development of anti-stress resistance, the high efficiency of dosed increasing stress factors, for example, various modifications of rhythmic hypoxic training (F.A. Iordanskaya. Health monitoring and functional preparedness of highly qualified athletes in the process of educational work and competitive activity. - M., 2006).

Recently, the method of transcranial electrical stimulation, which causes the mobilization of endogenous opioid peptides, has become widespread. The disadvantage of this method is its low efficiency, due to the fact that the effect on the ANS is carried out indirectly, through the central nervous system (V.V. Podolsky. The effectiveness of transcranial electrical stimulation in the complex treatment of patients with open fracture of the lower jaw: Abstract. Cand. Cand. Sciences. - Volgograd, 2009).

The use of non-pharmacological methods for the correction of the autonomic tone of the body is promising. At present, the high efficiency of applying the action of pulsed electric current to the zones of the cervical ganglia in order to correct the activity of the sympathetic ANS (electrophysical method for treating headaches, patent number: 2131274. Patent class: A.61N 1/00, A61N 1/32; Pat Electrophysiological method for the treatment of sensorineural hearing loss, Kublanov BC, Abdulkerimov Kh.T., Rodionova K.I. Talankina N. 3. - No. 2008136602/14; Claim. 09/11/08; publ. 04/20/10; Pat. RF №2157260 Electrophysical method for restoring the functions of the visual analyzer / Kublan V .S .; Declared 10.10.00).

In the literature we found a large amount of information about the positive effects of medium-intensity magnetic fields on the human body both locally and in general (BC Ulashchik, Resonance phenomena and their significance for physiotherapy. Issues of balneology 2006; Yu.N. Kholodov. Brain in electromagnetic fields , 1980). In the mechanisms of the therapeutic effect of MP, local and reflex levels can be distinguished.

The magnetic field has a certain biological activity and the ability to provide a preventive and healing effect on the human body. The energy of magnetic waves is converted into an active reaction of the human body and affects the physical properties of its cellular structures and organ systems.

It is known that when a magnetic field acts on an organism’s macromolecules (proteins, nucleic acids and other compounds), their energy increases. And this, in turn, affects the speed of biological processes and reactions that occur in the human body. A magnetic field improves the transfer of ions through cell membranes and improves the transmission of nerve impulses to fibers (A.L. Bunachenko, R.Z. Sagdeev, K.M. Salikhov. Magnetic and spin effects in chemical reactions - Novosibirsk, 1987).

The reaction to magnetic procedures is individual for each person. A common property of the effect of therapy is the corrective effect on the functioning of all organ systems: if any function is increased, magnetotherapy reduces it, and if it is reduced, it increases. Pathological reactions of the body are replaced by the opposite (A.M. Demetsky, A.G. Alekseev. Artificial magnetic fields in medicine. - Minsk, 1981). The magnetic field affects the functioning of neurovascular formations, reducing increased excitation and activating insufficient, thereby restoring balance.

An alternating magnetic field has a more pronounced healing effect than a constant.

The closest is a method of treating patients with fractures of the lower jaw using a magnetic field in the complex therapy of this group of patients (Erokina, NL "Modern methods for examining and justifying the pathogenetic treatment of inflammatory periodontal diseases in patients with fractures of the lower jaw," author. Diss. MD, Volgograd, 2009).

The treatment of patients with fractures of the lower jaw consisted of the following: after carrying out the standard generally accepted regimen, complex magnetotherapy including daily magnetic therapy (DMT) was applied daily, with a course of 8-10 procedures. The aim of the treatment was to reduce the number of complicated fractures, including due to improved blood flow in the damaged area. An indirect criterion for this was the assessment of the state of microcirculation in periodontal vessels, which was determined by analyzing the parameters of laser Doppler flowmetry. Blood flow in the inferior tracheal artery has not been studied. In addition, the authors did not analyze the vegetative manifestations of the stress reaction. Therefore, a comparison of treatment methods in this case can be based only on clinical indicators and the frequency of recorded complications.

DMT was carried out using a traveling pulsed magnetic field - the AMO-ATOS-E apparatus (Trima LLC, Saratov), the exposure was carried out by the magnetic field at the same time as the frequency of the emitted magnetic field (f1) and the frequency of the field modulation (scan) along the jaw (f2 ) The authors used the following values: f1 = 100 Hz, f2 = 10 Hz. At the same time, the exposure time is 15 minutes and 6-10 sessions per course. The choice of f1 and f2 values is due to resonance considerations with the rhythm of the electrical activity of the neuromuscular apparatus 4, 6 and the normal value of the alpha rhythm of the brain's EEG (10 Hz).

When used in the complex treatment of patients with fractures of the lower jaw in combination with inflammatory diseases of the periodontium DMT, the authors noted an almost 2-fold decrease in the number of purulent-inflammatory complications compared with patients who received conventional treatment (UHF fields were used as a physical therapeutic factor).

It has been established that patients with fractures of the lower jaw in combination with inflammatory periodontal diseases, circulatory disorders in periodontal tissues are significantly reduced when using procedures using the AMO-ATOS-E apparatus. The application of these procedures also allowed to significantly accelerate the consolidation of fragments of the lower jaw, in a short time to restore the sensitivity and trophism of tissues in the innervation zone of the lower pit nerve, which was characterized by the normalization of electrophysiological parameters.

This method includes local exposure in the zone of fracture of the lower jaw in order to restore blood flow as one of the most important factors in accelerating reparative processes. It is known that the activity of all mechanisms of regulation and self-regulation of local blood flow is controlled by three factors: neurogenic, predominantly sympathetic nature, metabolic and myogenic. The method does not contribute to the reduction of generalized sympathetic vasoconstrictor reactions; therefore, it does not affect the vegetative manifestations of stress reactions of the body as a whole and the neurogenic regulation of blood flow locally.

The essence of the proposed method for the treatment of patients with fractures of the lower jaw and identified autonomic disorders is to use, in addition to the traditional treatment, the impact of a pulsed traveling magnetic field on the projection of the autonomic cervical ganglia. It is aimed at blocking the activity of one of the neurogenic circuits of blood flow regulation, namely, postganglionic neurons and their branches innervating the arterial vascular system. Temporary suppression of neurogenic sympathetic control causes a decrease in the tone of arterial vessels, including small arteries and precapillary sphincters, and activates the work of endotheliocytes and smooth myocytes of the vascular wall. This leads to an increase in the flow of arterial blood and activation of the final trophic and metabolic processes.

The objective of the proposed method is to expand the therapeutic spectrum and increase the therapeutic effectiveness of magnetotherapy.

The method allows for a shorter time to achieve an equilibrium vegetative state of patients. This reduces the time of rehabilitation after an injury, provides faster recovery of disability, and a reduction in the percentage of complicated course of fractures.

The treatment method is as follows.

On the first day, traditional therapeutic measures (reposition, fixation of bone fragments) are carried out, antibacterial drugs are prescribed. From the 1st day of hospitalization and every day thereafter, they act with a pulsed traveling magnetic field on the projection area of the cervical sympathetic ganglia, using the Magnetic Sympatocor apparatus.

The device is intended for widespread use in medical institutions. The therapeutic effect, in our case, is achieved by correcting autonomic disorders in patients with fractures of the lower jaw by acting on the projections of the cervical ganglia of the patient’s sympathetic nervous system on the right and left by periodically blocking their activity with an induced pulsed traveling magnetic field (BMP) due to the self-induction effect. This is manifested in an increase in the general resistance of the body to the effects of adverse factors and has local manifestations in the form of improved blood flow in damaged tissues.

The placement of the emitters is carried out as follows: the tape emitter of the Magnetic Sympatocor apparatus is fixed around the neck and fastened with Velcro. Hats of the tape emitter have a semicircular section, are located on the side of the working surface and are combined into a set of inductors fixed in a flexible strip, represented by a textile material and a casing of a plastic film. The processing of the tape emitter (BMP) is not required, because exposure is non-contact (through a disposable napkin or plastic film).

The magnitude of the induction of the traveling magnetic field on the working surface of the tape emitter is 70 ± 10 mT. The modulation frequency of the BMP is 1.5, 10 Hz. The carrier frequency of the magnetic field is 50 Hz.

For safety, the device complies with GOST R 50267.0 and is made in terms of electrical safety as a class II product of type BF.

The magnitude of the magnetic induction corresponds to the general recommendations: permissible values in adults are 60-70 mT. Values below 20 mT do not lead to noticeable biological effects; more than 70 mT can lead to pathological reactions.

The duration of the procedure is 10-15 minutes daily with a course of 6 procedures. Treatment begins with exposure to a field with a frequency of 1 Hz (2 procedures), then the frequency increases to 5 Hz (2 procedures). The last 2 actions are carried out at a frequency of 10 Hz. A successive change of frequencies does not allow the development of resistance in tissues to the effects of a physical factor and allows you to constantly get a therapeutic effect. Frequency characteristics are selected empirically, but not by chance.

The device provides a resonant effect in the frequency range of the functioning of the basic systems of the body. Three fixed modulation frequencies of a running magnetic field: 1, 5, 10 Hz allow you to effect in synchronism with either the normal heart rate (1 Hz), or with the functioning of the central nervous system (5 and 10 Hz).

The positive local effect of BMP is assessed based on the improvement of blood flow in the lower tracheal artery according to rheovasography (RVH). The regulatory effect on the sympathetic section of the autonomic nervous system, manifested by a decrease in its activity, is established by the normalization of cardiointervalographic indicators, the concentration of catecholamines deposited in red blood cells.

We examined male victims (gender division is related to the specifics of the pathology: fractures of the lower jaw in women are much less common) aged 20 to 40 years, without severe somatic pathology, with a limitation period of injury of 1-2 days.

We examined patients with fractures, without displacement of fragments and with a displacement that succumbed to manual reduction and fixation with double-jaw splint teeth.

All patients were divided into 2 groups: 1 group of patients received a course of traditional treatment (30 people): group 2, in addition to generally accepted methods of treatment, received additional physiotherapeutic treatment using a pulsed traveling magnetic field generated by the Magnetic Sympatocor apparatus (40 people).

All patients at admission were tested using the AM Wayne questionnaires (AM Wayne. Autonomic disorders: Clinic, treatment - Moscow: MIA, 2003; AM Wayne. Classification of autonomic disorders, Neuropathology and Psychiatry. - 1988. - No. 10) to establish the presence of severe violations autonomic nervous system before injury.

The results of the assessment of the questionnaires showed that there was no significant difference in the indicators in the groups.

When analyzing the questionnaire used to identify signs of autonomic changes before the moment of injury (the answers to the questions corresponded to the health period), the patient filled out the admission and set a score of 7, 8, which corresponds to the absence of expressed violations from the IUD before the injury. Signs of autonomic imbalance is a total score of 15 or higher.

Then, a clinical examination of patients was carried out against the background of the proposed treatment, the data were compared with the prototype. An assessment of hemodynamic parameters was used as a clinical indicator of the manifestation of autonomic reactions.

Table 1 Comparison of hemodynamic parameters in patients with fractures of the lower jaw in the dynamics of various types of treatment. Admission metrics Prototype, 7th day of treatment Magnetic sympathocor, 7th day of treatment Norm Heart rate, beats per minute 84 ± 2.2 77.5 ± 1.5 70.8 + 1.8 60-68 HELL, mmHg Art. 145 ± 1,5 141 ± 1.2 130.4 ± 2 120-124 ADD, mm RT. Art. 86 ± 1.2 79.6 ± 1.7 74.8 ± 0.8 76-80 Pulse pressure, mmHg Art. 59 ± 2.3 mm 68.3 ± 1.3 50.8 ± 1.4 40-44

In the group of patients who were additionally exposed to a traveling pulsed magnetic field, the average heart rate after treatment was 70.8 ± 1.8, whereas against the background of the compared treatment method, 77.5 + 1.5 per min, the average BP at the time of discharge was at the level of 130.4 ± 2, which is lower than in the comparison group. Blood pressure also decreased - 74.8 ± 2.4, pulse pressure 50.8 ± 1.8 mm Hg. compared with 68.3 ± 1.3 in the comparison group.

From the above data it is seen that the hemodynamic parameters in both groups remain above normal, i.e. the predominance of sympathetic influences remains, but in the group of patients who received treatment with the proposed method, all indicators are lower, that is, closer to normal.

Upon admission to all patients, the Garkavi lymphocyte-neutrophil index was determined (L.Kh. Garkavi, E.B. Kvakina, M.A. Ukolova. Adaptation reactions and body resistance - Rostov-on-Don: Rostov University Press, 1990) general blood test data. Its average value was 0.28 ± 0.014. And according to our data, 80% of patients were stressed.

Lymphocyte-neutrophil index score scale

- less than 0.30 - STRESS,

- 0.31-0.50 - reaction of training,

- 0.51-0.70 - reaction of calm activation,

- greater than 0.71 - reaction of increased activation.

Estimating the Kerdo index (I.Kerdo, 1963) in the group, the treatment of which was carried out additionally using the Magnetic Sympatocor apparatus, we found that, upon receipt, the index values averaged + 5.5 ± 0.25, which also reflects activation sympathetic division of the ANS. After the treatment, the index was 2.7 ± 1.5, which approaches normal values (2.3 ± 1.8 units).

The Hildebrant index after a course of treatment using the Magnetic Sympatocre apparatus averaged 5.3 ± 0.1, which is close to the upper limit of the norm (at a rate of 2.8-4.9) and indicates the restoration of the equilibrium intersystem state. The higher the numbers of this indicator, the higher the activity of the sympathetic division of the ANS.

The data obtained are evidence of the restoration of the balance of autonomic reactions during treatment with the use of the Magnetic Sympatocor apparatus.

To study vegetative tone, reactivity, and activity support, an analysis of heart rate variability (HRV) was performed using cardiointervalography (CIG). Various standard indicators were evaluated, but the most informative and clinically significant was the determination of the tension index (IN), the level of which was assessed during various stress tests.

The study began when the patient was lying down (after 10 minutes of rest), all data is encoded with the letter f (background indicators), then the test person got up slowly and the study was repeated (the sample is called clinotortostatic, coded as co ), then for 10 minutes (with registration of cardiointervalograms on 6th and 11th minutes) indicators were recorded again. Samples are called orthostatic: the first and second are respectively encoded as o1 and o2 . Then the patient went to bed, the sample is called clinostatic and the data is encoded by the letter k .

Vegetative support of activity (WAT) is assessed as sufficient, excessive and insufficient in relation to IN in a clino-orthostatic sample to background indicators (Inco / INF), at the 6th minute of orthostasis to the background (INo1 / INF) and IN at the 11th minute of orthostasis to background (INo2 / INF). The type of reaction to the orthostatic load was determined, respectively, according to the CIG data in the 1st and 2nd orthostatic tests (ratio of INF to Ino1 and Ino2), the recovery period in relation to INF to Inc.

In the literature, we found only normal background indicators of ID. And there are no IN indicators in the samples. Therefore, in the analysis, we were guided by the dynamics of changes in the indicated index in the samples. Background measurements and clinostatic data were compared with normal levels.

table 2 The age norm of tension index indicators Indicators Age norm IN, cu 127.98 (80-140)

When the ratio of background IN and IN in the samples is from 0.7 to 1.5, the body reaction is regarded as moderate sympathicotonia, which is normal during physical exertion. As a result of the IN ratio of more than 1.5, the reaction is regarded as hypersympathicotonia and reflects a pronounced imbalance and intensity of the reactions of regulation of vegetative processes.

Table 3 The ratio of IN in samples to IN background at admission and during treatment using the Magnetic Sympatocor apparatus. Upon enrolment Treatment using the Magnetic Sympathocore Inco / INF 1.68 1.27 HHO1 / INF 3.09 3.14 INo2 / INF 5.93 0.84 INC / INF 1.15 0.8

When patients were admitted to hospital for inpatient treatment at the Department of Maxillofacial Surgery, most of them registered severe sympathicotonia, hypereympathicotonic reactivity, excessive autonomic activity, and an extended recovery period.

All data obtained are a reflection of the pronounced activation of the sympathetic division of the ANS. A violation (perversion) of indicators during the course of the tests indicates the tension of the adaptation mechanisms, which can lead to a failure of adaptation and, as a result, an increase in the number of complications, both local and general.

Against the background of treatment of patients with the proposed method, we noted a tendency to normalize the autonomic reactions of the body in patients:

after a natural increase in a number of indicators in a wedge-orthostatic sample and the 1st orthostatic sample, they begin to decrease in the 2nd orthosgatic sample, and this phenomenon continues at the stage of a clinostatic test, the level of indicators tends to normal, although slightly increased (sipaticotonia persists). This reflects the rapid restoration of the vegetative balance, an increase in the adaptive capabilities of the organism as a whole.

The method proposed by A.PL Map Dar, D.P. Kladienko (A.I. Mardar, D.P. Kladienko Cytochemical method for detecting catecholamines in red blood cells. Laboratory. - 1986. - No. 10), the number of granules of catecholamines (CA ), deposited in red blood cells as an indicator of the severity of the stress reaction and the dynamics of recovery after it.

The enumeration of granules of catecholamines deposited in red blood cells in patients with fractures of the lower jaw upon admission was 3315 ± 500 granules per 100 red blood cells. We have determined that the level of CA in practically healthy men aged 20 to 40 years is on average 96 ± 10.

In the figure 1: A blood smear of a patient with a fracture of the lower jaw upon admission, where 1 is a red blood cell,

2 - ranules of catecholamines deposited in red blood cells.

The concentration of blood CA after the course of treatment with Magnetic Sympathocor was 740 ± 30 at the time of discharge, which is almost 4 times lower than the same parameters at admission.

In the figure 2: Blood smear of a patient with a fracture of the lower jaw on the 7th day of magnetotherapy using the device "Magnetic Sympatocore",

where 1 is a red blood cell,

2 - granules of catecholamines deposited in red blood cells.

This study confirms the results obtained by other research methods: pronounced activation of the sympathetic ANS (CA - are mediators that realize the clinical effects of this department of the ANS) in patients upon admission. After the course of treatment proposed by us, the activity of sympathetic influences sharply decreased, which is an expression of the restoration of the vegetative balance.

To assess blood flow in the lower tracheal artery, the rheovasography (RVH) method was used. Due to the young age of the patients and the absence of a pronounced somatic pathology before injury, it is not advisable to evaluate the indicators of intravasal blood flow disturbance (since they reflect the organic pathology of the endothelium and vascular wall) the most clinically significant indicators of blood flow disturbance due to extravasal exposure (vascular compression by edema of the surrounding tissues , damage or compression of the vessel wall by displaced fragments and, as a result, a decrease in the diameter of the lumen of the vessel), we chose to determine the maximum th and minimum blood flow velocity of systolic blood flow (V _max and V _min respectively).

Table 4 Comparison of hemodynamic parameters of RVG at admission and during treatment with the use of the Magnetic Sympatocor apparatus. Before treatment After treatment Almost healthy V _max V _min V _max V _min V _max V _min 67.7 ± 3 18.2 ± 2.5 42.8 ± 4 9.9 ± 1.0 33.4 ± 3.5 4.8 ± 2.0

From the above table it follows that during treatment, blood flow in the lower tracheal artery improved significantly, which entails an improvement in trophic bone tissue and, as a result, relief of clinical manifestations of trauma (both local and general).

The following indicators and their dynamics were used as a clinical evaluation of treatment effectiveness: body temperature, pain in the lower jaw and surrounding soft tissues, severity of perifocal tissue edema.

Upon admission, the body temperature of patients with fractures of the lower jaw is fixed at subfibril numbers - 37.5 ° C.

The dynamics of a decrease in the manifestation of clinical symptoms are shown in the table.

Table 5 Expert assessment of the dynamics of clinical indicators in patients with fractures of the lower jaw (in days). Pain Edema Body temperature Magnetotherapy 1.1 ± 0.2 2.6 ± 0.2 1.9 ± 0.2 Prototype 2.0 ± 0.4 3.0 ± 0.2 2.5 ± 0.3

The complicated course of fractures of the lower jaw in the form of suppuration of the bone wound, soft tissues against the background of the treatment method we proposed was 7%, while in the treatment by the prototype method it was 16.5%.

Clinical example

Patient V., 29 years old, medical history No. 10243. He entered the maxillofacial department 13.10.10. with a diagnosis of Bilateral fracture of the lower jaw: an angle on the left, the mental department on the right.

From the anamnesis: I received a lower jaw injury on 10/12/10 in a fight with an unknown person (1 day before hospitalization).

Upon admission, body temperature is fixed at 37.6 ° C.

When analyzing the questionnaire used to identify signs of autonomic changes, filled by the patient upon admission, the score was set at 7.8, which corresponds to the absence of pronounced disorders of the ANS before injury.

The level of lymphocytes in the general blood test was 20, neutrophilic white blood cells - 75, so the Garkavi index was 0.27, which is a reflection of the manifestation of stress.

HELL 140/80 mm RT. Art., pulse pressure 60 mm RT. Art.

Pulse at rest 85 beats per minute

Kerdo Index 5.9

Hildebrant Index 7.8

Investigations of vegetative tone, reactivity, and provision of activity were carried out by analyzing HRV by CIG (namely, IN and its changes in the course of stress tests).

Table 6 Rhythmogram IN, cu Background 590 Clinoorthostatic test 1454 1st orthostatic test 1790 2nd orthostatic test 2500 Clinostatic test 531 Original vegetative tone sympathicotonia Vegetative Reactivity hypersympathicotonic reactivity Vegetative support activities excess Recovery period lengthened (fatigue reaction)

INCO / INF - 3.13; INONINf - 2.22. INo2 / INF - 7.7, Inc. / INF - 1.8.

CIG data are a reflection of the pronounced activation of the sympathetic ANS link.

According to the results of the RVG: Vmax 85.9, Vmin 25.1

On the day of admission, Tigerstedt double-jaw tires were applied with hook loops under local anesthesia. The bite is restored, fixed with rubber traction. A solution of lincomycin 30% - 2 ml was prescribed, intramuscularly, 3 times a day. Additionally, an MT course was conducted using the Magnetic Sympatocor apparatus. On the first day, magnetotherapy was started: magnetic field induction - 60 mT, frequency 1 Hz, exposure time 15 min. The exposure in this mode was carried out for 2 days, then the frequency of the BMP was increased to 5 Hz, 2 procedures were carried out, in the remaining 2 days of hospitalization, the frequency of the BMP was 10 Hz. On the 2nd day from the beginning of physiotherapy, the patient noted the disappearance of pain in the lower jaw, and during the next 6 days of hospitalization, the traumatic edema of the soft tissues almost completely disappeared, the pain in the lower jaw did not bother. Body temperature returned to normal.

On the 1st day of the hospital period, a control examination was conducted in the same volume.

HELL 120/78 mm RT. Art., pulse pressure 42 mm RT. Art.

Pulse at rest 70 beats per minute

Kerdo Index 1.1

Hildebrant Index 5.3

Table 7 Analysis of heart rate variability according to cardiointervalography Rhythmogram AI, cu Background 70.89 Clinoorthostatic test 222.17 1st orthostatic test 15737 2nd orthostatic test 547.5 Clinostatic test 125.26 Original vegetative tone Sympathicotonia Vegetative Reactivity Hypersympathicotonic reactivity Vegetative support activities Excess Recovery period Lengthened

Inco / INF - 2.46, InoUINf - 3.03, Ino2 / INF - 4.24, Inc / INF 0.9.

These ratios demonstrate persistent sympathicotonia, but during the course of the samples they show an adequate reduction reaction, almost to the initial level.

According to the results of the RVG: Vmax - 60.1, Vmin - 13

When comparing RVG data, a significant improvement in blood flow in the lower hole of the artery is determined.

During the hospital period, the patient felt a subjective improvement, the pain disappeared on the 2nd day from the start of magnetotherapy, soft tissue edema at the time of discharge was practically not determined. No signs of suppuration of the bone wound or surrounding soft tissue were found. The patient was discharged for outpatient treatment to a dental surgeon at the place of residence.

Using the proposed method leads to blocking the activity of the ganglia and weakens the tonic effect on the blood vessels, resulting in an increase in blood supply to organs (in our case, the organs of the maxillofacial region, which in turn leads to an increase in reparative processes in the bone due to improved blood flow in the lower hole arteries).

From the above data from the examination of patients and the clinical example, it is seen that due to the above therapeutic effects, the following advantages are provided (positive effect). Reducing the duration of inpatient treatment due to more rapid relief of post-traumatic events (edema, tissue infiltration, hematomas). Faster relief of pain, lack of need for analgesics. Reducing the number of complications of an infectious and inflammatory nature (suppuration of a bone wound, traumatic osteomyelitis, suppurative hematomas). Reducing the duration of treatment and rehabilitation measures due to the listed therapeutic effects. There is no need for long-term outpatient aftercare.

Claims (1)

A method of treating patients with fractures of the lower jaw, including exposure to a magnetic field, characterized in that they affect the projection areas of the sympathetic cervical ganglia with a pulsed traveling magnetic field with an induction of 60 mT, a frequency of 1 Hz in the first two days, a frequency of 5 Hz on the third and fourth days, a frequency 10 Hz on the fifth and sixth days, for 15 minutes

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