RU2551959C2 - Method of preventing thrombosis of deep veins of lower extremities in carrying out hip joint endoprosthetics - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to physiotherapy. Method includes electroneurostimulation (ENS) of gastrocnemius muscles, intake of direct anticoagulants, wearing elastic stockings. Before operative intervention through applied on both gastrocnemius muscles electrodes individual parameters of intensity of influencing pulse current, characterised by visible contraction of gastrocnemius muscle, are determined. After that, first procedure of gastrocnemius muscle ENS is performed for both extremities. Second ENS procedure is performed in the course of operative intervention only on extremity which is not operated. After finishing operation and termination of anaesthetic effect the following procedure of gastrocnemius muscle ENS is performed on both extremities. Procedures are repeated every 4-6 hours for the following days until patient starts to move independently by means of crutches. Time of ENS procedure constitutes 20 minutes.

EFFECT: method ensures prophylaxis of thrombosis of deep veins of lower extremities in the process of operative intervention due to active impact on muscles of lower extremities.

1 ex, 1 dwg

Description

The invention relates to medicine, in particular to orthopedics. It is used to reduce the risk of thromboembolic complications during major interventions on the lower extremities.

With the surgical treatment of diseases or the consequences of lower limb injuries, there is a risk of deep vein thrombosis, which, in turn, can lead to thromboembolism and death of the patient. This complication occurs at various times after surgery, but the period before verticalization (the beginning of the patient's movement) and up to 35 days after the intervention is considered the most dangerous.

An effective means of preventing thromboembolic complications is the appointment of anticoagulants. However, one of the complications of their use is the risk of bleeding, especially in the early postoperative period. In this regard, the use of anticoagulants is possible only a few hours after the intervention. During this period, the prevention of the development of blood clots of the deep veins of the lower extremities is sharply limited. Despite the appointment of these drugs, mortality from thromboembolic complications remains high. Traditionally, along with medicines, indirect prevention methods are used: the earliest possible activation of the patient, elastic knitwear and intermittent mechanical compression on the lower extremities [1]. However, the closest prior art, i.e. The prototype can be considered a method for the prevention of deep vein thrombosis of the lower extremities, carried out when replacing large joints, including and for hip replacement, including electroneurostimulation (ENS) of the lower leg muscles, early activation of patients, taking anticoagulants, wearing elastic knitwear. The problem point of their use is the passivity of the impact on the soft tissues of the lower extremities [2].

The invention consists in a combination of essential features that ensure the achievement of the desired technical result, such as an active effect on the muscles of the lower extremities during the patient’s stay in bed.

The essential features of the invention are that prior to surgery, the electrodes applied to both calf muscles determine the individual parameters of the force of the acting impulse current, characterized by a visible reduction in the calf muscles, after which the first procedure of the calf muscles of both limbs is performed, the second procedure is performed during interventions only on the non-operated limb, and after the end of the operation and the action of anesthesia, the following gastrointestinal enns procedure is performed muscles of both legs, for the next day the procedure was repeated every 4-6 hours until the beginning of the patient's own movement with crutches, the time of the EDF procedure is 20 minutes.

The advantages of this method are:

- Lack of individual intolerance to electroneurostimulation of muscles in patients.

- Individual selection of the degree of impact on the muscles.

- Prevention of blood clots at each stage of treatment: before, during and after the intervention.

- Compatibility of the method with any anesthesia method. +

- The absence of restrictions on the timing of the course of electroneurostimulation of the muscles of the lower extremities, including at the outpatient stage.

- The possibility of unlimited application of the proposed method in combination with the use of anticoagulants and wearing elastic knitwear.

- Patient mobility before and after surgery due to the possibility of using a portable design of an electroneurostimulator.

The method of applying electrodes for the ENS according to the claimed method is illustrated in the drawing, which shows a photograph of the location of the electrodes in the projection of the calf muscles of both limbs.

THE METHOD IS CARRIED OUT AS FOLLOWS.

Immediately before the surgery, standard electrodes are attached to the calf muscles of both legs and, connecting them to the electroneurostimulator, the strength of the electric signal on the patient’s muscles is selected. As a rule, an effective effect is characterized by a visible reduction in the calf muscle and the absence of unpleasant sensations for the patient. Before the intervention, the first procedure is carried out, and its duration is limited to 20 minutes, which is automatically provided for by the capabilities of the electrical neurostimulator.

Next, the electrode is removed from the operated leg, and an elastic bandage or anti-varicose knitted stocking is applied over the electrode to the opposite limb.

The patient is appropriately laid, anesthetized, the treatment of the surgical field and the intervention itself. During the operation on a symmetrical limb, another procedure is performed.

After the end of the intervention and the dressing of the surgical wound, an electrode is placed on the calf muscle and an elastic bandage (or stocking) on the operated leg. After the end of the action of anesthesia, the following electroneuromyostimulation procedure is performed for a duration of 20 minutes. The procedures are repeated every 4-6 hours for 20 minutes until the patient can be mobilized (verticalized). Extension of the treatment period with the use of electroneuromyostimulation of the muscles of the lower extremities is possible by decision of the doctor in patients with an increased risk of thrombosis (chronic vascular insufficiency, history of thrombosis, etc.).

CLINICAL EXAMPLE. Patient M., 58 years old. He was admitted to the hospital for dysplastic coxarthrosis after reduction in childhood of congenital dislocation of the left thigh. In January 2012, the patient underwent total arthroplasty of the left hip joint. Prior to surgery, electrodes were placed on both calf muscles, and individual parameters of the current pulse were determined. A 20-minute procedure of electroneurostimulation of the calf muscles of the lower extremities was performed. An electrode was removed from the operated leg, and an elastic bandage was applied to the opposite limb. During surgery on the right extremity, the second procedure of electroneurostimulation of the gastrocnemius muscle was carried out lasting 20 minutes. After the operation is completed, an electrode and an elastic bandage are sequentially applied to the operated leg. At the end of the action of anesthesia, the subsequent procedure of the ENS of the calf muscles of the lower extremities of the patient was carried out. During the day, 4 more procedures were performed for 20 minutes each, until the patient began independent movement with the help of crutches.

In parallel with the ongoing ENS procedures, the patient was prescribed direct anticoagulants and wearing elastic knitwear, which was extended for another 34 days. Over the entire period of inpatient and further outpatient treatment, data for venous thrombosis of the lower extremities were not revealed.

Information sources

1. Prevention of venous thromboembolic complications in traumatology and orthopedics. Russian clinical guidelines // Traumatology and Orthopedics of Russia. - 2012, No. 1. Application. S.1-24.

2. Akhtyamov I.F. et al. The first experience of combined thromboprophylaxis in arthroplasty of the lower extremities: prospects and use cases // Traumatology and Orthopedics of Russia. - 2012, No. 1. - S.98-103.

Claims (1)

A method for the prevention of deep vein thrombosis of the lower extremities during hip joint endoprosthetics, including electroneurostimulation (ENS) of the calf muscles with the simultaneous use of direct anticoagulants, wearing elastic stockings, characterized in that before the surgical intervention, the individual impulse force parameters are determined through the electrodes applied to both calf muscles current, characterized by a visible reduction in the calf muscle, after which the first gastrointestinal ENS procedure is performed x muscles of both extremities, the second ENS procedure is performed during surgery only on the non-operated limb, and after the operation and anesthesia are completed, the following procedure is performed for the calf muscles of both limbs, during the next day the procedure is repeated every 4-6 hours, until the start of an independent the patient’s movement with crutches, while the time of the ENS procedure is 20 minutes.

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