RU2699963C1 - Method of treating post-traumatic contractures of small hand joints - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopedics, and can be used for treating post-traumatic contractures of small hand joints. That is ensured by administering 0.5 ml of low-molecular hyaluronic acid on the first day of treatment to the area of collateral ligaments of the fingers, along the medial and lateral sides. On 7th day of therapy, in the same area of collateral ligaments, 0.5 ml of plasma enriched with thrombocytes (PRP), which is 1,000,000–1,200,000 cells, is introduced. On the following days, after each type of injections, a course of rehabilitation procedures is carried out, aimed at developing motions in the injured joint and adjacent joints.

EFFECT: method provides recovery and improvement of finger function with possibility of early motor rehabilitation due to increased elasticity of connective tissue and stimulation of regeneration and revascularisation of tissues in affected joint.

1 cl, 3 dwg, 1 ex

Description

The invention relates to medicine, specifically to traumatology and orthopedics, and can be applied to restore, or improve, the function of the fingers in post-traumatic contractures.

Joint damage is observed in approximately 41% of the total number of hand injuries, approximately 1/3 of them lead to long-term disability due to the occurrence of varying degrees of joint contractures [1]. The development of contractures is based on a pathological mechanism in which prolonged immobilization leads to the formation of abnormal transverse compounds in collagen fibers of collateral ligaments [2].

There is a method of treating post-traumatic contractures with a stage splint. According to this method, the stage-by-stage application of plaster casts is performed as the finger is brought out to a physiological position, followed by rehabilitation treatment [3]. However, this method is more suitable in the treatment of contractures, which are based on the tendogenic mechanism, because it does not take into account pathological mechanisms of development.

The closest, in its technical solution, to the proposed method is a method in which a distraction apparatus is applied to the area of adjacent tubular bones of the damaged joint. Then the joint is stretched, plasma enriched with platelets is introduced into its cavity, which releases the factors of joint restoration. Subsequently, the distraction apparatus is dismantled, and rehabilitation treatment is prescribed to the patient [4]. The disadvantages of the method are the high complexity, the need for an operating room to apply a distraction apparatus, τ and adherence to aseptic alertness in order to prevent inflammation of the spokes. It should be noted that this method is most effective for more serious injuries, in which, in addition to contracture, joint ankylosis is formed.

The invention consists in the combination of essential features sufficient to achieve the desired technical result, consisting in the simplicity of the treatment method and its short period, with the possibility of early active rehabilitation.

The essence of the method for the treatment of post-traumatic contractures of the small joints of the hand includes the use of platelet-rich plasma. On the first day of treatment, 0.5 ml of low molecular weight hyaluronic acid is introduced into the area of the collateral ligaments of the fingers of the hand, on the medial and lateral side. On the 7th day, in the same area of the collateral ligaments, 0.5 ml of platelet-rich plasma (PRP), which amounts to 1,000,000-1,200,000 cells, is given. In the following days, after each type of injection, a course of rehabilitation procedures aimed at developing movements in the damaged joint and adjacent joints is carried out.

The introduction of 0.5 ml of the preparation of low molecular weight hyaluronic acid in the area of both collateral ligaments of the joint on the first day of treatment ensures rehydration of the soft tissues, which increases their elasticity. The principle of action of hyaluronic acid is based on the rehydration of dehydrated paraarticular joint tissues, due to which wrinkling of collagen fibers occurs, and the formation of abnormal transverse joints. As a result, the degree of extensibility is significantly reduced, and the stiffness of tissues increases [2].

The introduction of PRP is carried out according to the YCELLBIO protocol: in a syringe with a volume of 20 ml, 1.5 ml of anticoagulant are collected and 15 ml of the patient's venous blood is taken. The resulting blood is placed in a special test tube YCELLBIO-KIT, and two-stage centrifugation is performed (1 - 3500 rpm - 4 minutes; 2 - 3500 rpm - 2 minutes).

The principle of PRP is based on the delivery to the pathological zone of natural factors involved in the recovery processes of the body. Platelets in their alpha granules contain a diverse group of polypeptides that contribute to the transformation of growth factors involved in tissue regeneration and revascularization [5].

The sequence of drug administration is based on their therapeutic properties. The use of low molecular weight hyaluronic acid can increase the elasticity of connective tissue due to the breaking of the transverse bonds of collagen fibers. The introduction of platelet-rich plasma (PRP) into the same region promotes tissue revascularization in the affected joint.

The amount of injected hyaluronic acid and platelet-rich plasma in an amount of 0.5 ml at a single injection point was selected based on the recommendations of the manufacturers of hyaluronic acid and a test tube using which an enriched plasma is obtained, which corresponds to the YCELLBIO-KIT protocol [6].

The time for re-injection of PRP 7 days after the administration of low molecular weight hyaluronic acid was selected based on the recommendations of the manufacturer of this acid. This periodicity is explained by the duration of the drug, which creates a depot of hyaluronic acid at the injection point, with its subsequent isolation [6].

Active rehabilitation treatment carried out in the days following the execution of each type of injection helps to eliminate contracture in the interphalangeal joints.

The method is illustrated in the illustrations, where:

In FIG. 1 - radiograph of the brush of patient D. before treatment;

In FIG. 2 - function of the joints of the hand before treatment;

In FIG. 3 - function of the joints of the brush of patient D. 3 weeks after the treatment.

The method is as follows.

On the first day of treatment, 0.5 ml of a low molecular weight hyaluronic acid preparation is injected into the area of the collateral ligaments, on both sides of the damaged joint. On the seventh day, in the same region of the collateral ligaments, from the medial and lateral sides, injections of plasma enriched with platelets (PRP) in a volume of 0.5 ml (1,000,000-1,200,000 cells) are performed once. After performing each type of injection, the patient is prescribed a course of rehabilitation procedures aimed at developing movements in the injured and adjacent joints.

Clinical example.

Patient D., in May 2018, appealed to the GAUZ “RKB MZ RT” with a complaint about the restriction of movements of the second finger of the left hand. For 1 year before, she received an open fracture of the main phalanx of the 2 fingers of the left hand, turned to the Central Clinical Hospital, where she underwent primary surgical treatment and osteosynthesis with knitting needles. During the year, D. repeatedly, unsuccessfully, underwent rehabilitation treatment at the clinic at the place of residence. Diagnosis at admission: mixed contracture of the proximal and distal interphalangeal joint of the second finger of the left hand. The condition of the bones of the hand of patient D. and the function of the joints of the hand upon admission to treatment are shown in FIG. 1 and FIG. 2.

Patient D. underwent a course of treatment according to our proposed method: on the first day of treatment, 0.5 ml of a low molecular weight hyaluronic acid preparation was injected into the collateral ligament area on both sides of the damaged joint. On the seventh day of treatment, in the same area of the collateral ligaments, from the medial and lateral sides, injected plasma enriched with platelets (PRP) in a volume of 0.5 ml (1,000,000-1,200,000 cells). After each type of injection, the patient underwent a course of rehabilitation procedures aimed at developing movements in the damaged joint and adjacent joints. As a result of the treatment, the function of the finger of the hand improved significantly. FIG. 3. The patient is satisfied with the result of the treatment.

Information sources.

1. Skvortsova M.A. Surgical treatment of closed injuries of the ligaments of the joints of the fingers: Dis. Cand. honey. sciences. Moscow; 2003.

2. Akeson W. H., Amiel D., Woo S. (1980). Immobility effects on synovial joints: The patho-mechanics of joint contracture. Biorheology, 17 (1/2), 95-110.

3. Afonichev K.A. To the Question of Free Skin Tummy in Reconstructive Surgery of Burns in Children. Pediatric Traumatology, Orthopedics and Reconstructive Surgery - 2017 -t. 5 - Vol. 1 - p. 39-44.

4. RF patent No. 2626591 A61B 17/56, BI No. 22, 07.28.2017.

5. Hoenig J.M., Heisey D.M. The abuse of power: The pervasive fallacy of power calculations for data analysis. Am Stat 2001; 55: 19-24.

6. Khabarov B.H., Selyanin M.A., Zelenetskiy A.H. Solid-phase modification of hyaluronic acid for aesthetic medicine // Bulletin of aesthetic medicine. 2008. No7 (3). S. 2-7.

Claims (1)

A method of treating post-traumatic contractures of small joints of the hand, including the use of platelet-rich plasma, characterized in that on the first day of treatment 0.5 ml of low molecular weight hyaluronic acid is introduced into the area of the collateral ligaments of the fingers of the hand, on the 7th day, in the same area of the collateral ligaments, injected with 0.5 ml of platelet-rich plasma (PRP), which is 1,000,000-1,200,000 cells, in the following days, after each type of injection, a rehabilitation course procedures aimed at developing movements in the injured joint and adjacent joints.

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