RU2741970C1 - Method of treating patients with lumbosacral dorsopathy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to reflex therapy, neurology and medical rehabilitation, and can be used for treating patients with lumbosacral dorsopathy. After preliminary treatment of skin with antiseptic solution, Alflutop preparation is introduced into the area of points chosen according to reflexotherapy rules and alternated during the course: segmental in lumbosacral region - T3-5, V2Z, 25, 27, V31–34 and distant points - on lower extremities - V39, 40, 57, 60, 62, E36, VB 30, 34, 39, including vascular points RP6.9, F2.3; 6–8 points are used during the procedure: 2–3 segmental and 4–5 remote. Latter are preferably selected on the side of the lesion. In the case of reflex syndromes, selection of points is determined by localization of pathological manifestations, radicular - by a zone of innervation of involved nerve roots, vaso-reflex reactions - a projection of the first lateral line of back in a combination with vascular points RP 6, 9, F 2,3. Alflutope 0.2 ml is injected subcutaneously into each of the points. Therapeutic course includes 10 procedures released every other day.

EFFECT: method provides reduced length of treatment, fast regression of clinical symptoms, namely in the form of pronounced regression of pain sensations, increased volume of active motions in lumbar spine, neurovascular disorders, confirmed by special study results, with no negative events and reduced recurrence rate due to introduction of the preparation into the points chosen according to reflexotherapy rules.

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Description

The proposed invention relates to the field of medicine, namely to the sections of reflexology, neurology and medical rehabilitation and can be used in medical institutions of various profiles.

A feature of lumbosacral dorsopathies is a high prevalence, at the level of a pandemic, and a progression of the course associated with the frequency of relapses. The characteristic long-term disability of patients often ends with their disability (E.V. Podchufarova, 2012, I.V. Kuzmina, 2015, L.G. Agasarov, 2017, and others).

Therapeutically, for dorsopathies, typical is resistance to the generally accepted effects, especially in the case of dominance in the clinical picture of the neurovascular component (Ya.Yu. Popelyanskiy, 2003, M. Goossens, S. Evers, 2007, I.V. Kuzmina, 2015) ... This fact explains the growing interest in innovative options for correction and, first of all, simultaneous reflex-medication exposure (L.G. Agasarov, 2010, 2017, S.K. Makina, 2012).

Among such technologies, pharmacopuncture is known - the introduction of various agents, mainly medicines, into the area of reflexotherapy points (L.G. Agasarov, 2015, 2017, I.V. Kuzmina, 2015, A.V. Boldin, 2017, etc.). Technically, the method consists in a subcutaneous injection of 0.2-0.3 ml of the drug indicated for a certain pathology into the projection of 6-8 points of reflexology. It has been shown that the results achieved in this case exceed the simple summation of the reflex and drug effects (L.G. Agasarov, 2002).

In terms of explaining this phenomenon, a number of key links are distinguished in the mechanisms of the method, including prolonged stimulation of points due to changes in their volumetric characteristics (L.G. Agasarov, 2002, 2015; I.V. Kuzmina, 2015). Multiple drug depots also differ in therapeutic value (G.A. Mkhitaryan, 2006). Also, they do not exclude the possibility of interaction between the active substance of the drug and the point itself (A.V.Boldin, 2005).

In this regard, the question arises about the nature of the drugs used for pharmacopuncture. At the same time, the overwhelming majority of known works were performed using homeopathic complex preparations, characterized by a high dilution of components (N.E. Putilina, 2001, A.A. Mikhailova et al., 2003, V.A. Boldin, 2005, I.V. Kuzmina , 2015, etc.). This very moment is the basis for hypothetical ideas about the intimate mechanisms of contact between the drug and the point (V.A.Zhuravlev et al., 2010).

On the other hand, a small number of sources indicate the effectiveness of the use of pharmacopuncture in dorsopathies with "classical" drugs and, first of all, the chondroprotector Alflutop (Biotechnos, Romania). So, in one of the first works (L.D. Makarova et al., 2006) on the topic, the superiority of this approach (outside of its special detailing) over classical acupuncture was demonstrated. Moreover, in this case, given the short duration of the treatment cycle, which includes 10 injections, we are talking about predominantly analgesic, and not actually chondroprotective effect of the drug.

Based on these data, we have proposed a method for introducing Alflutop into points, carried out according to the rules of reflexotherapy, which presuppose a mandatory combination of segmental and distant (including "vascular") points in the selection of points. This approach, which is easy to implement, effective and safe, has a fast onset and long lasting effect.

At the same time, there is a known method of injecting Alflutop into the area of trigger points (in fact, a simplified version of pharmacopuncture) against the background of frequency-wave therapy, characterized by a modifying effect on vertebral tissues. The treatment cycle included 10 procedures for injecting the drug into tissues (S.K. Makina, 2013).

The disadvantage of the presented method is the use of exclusively trigger points, without taking into account the rules of reflexology, thus excluding its therapeutic mechanisms. In addition, parallel implementation of frequency-wave therapy is not available at all medical institutions. These moments, naturally, reduce the effectiveness of the impact.

The closest in technical essence to the proposed method is fractional (0.15-0.2 ml) introduction of Alflutop into the paravertebral and distant points of the "bladder" meridian, located along the posterior-median surface of the lower extremities. The course of exposure consisted of 10 procedures, carried out every other day (OA Tikhaya, 2007).

The main disadvantage of this technology is the choice of points of only one meridian strictly oriented on the surface, while the pain "pattern" can shift, determining the need to influence points and other, otherwise located meridians. This, in turn, reduces the effectiveness of therapy, which is also manifested in a high risk of exacerbations of dorsopathy.

The technical result of the proposed method is to increase the efficiency of treatment of patients with lumbosacral dorsopathy in the form of a reduction in treatment time, rapid regression of pain and other pathological sensations, reduction of clinical symptoms in the form of an increase in the volume of active movements in the lumbar spine, a decrease in the severity of myo-dystonic and vascular manifestations , in the absence of negative phenomena and a decrease in the frequency of relapses.

The specified technical result is achieved as follows.

After pretreating the skin with an antiseptic solution, Alflutop is injected into the area of points selected according to the rules of reflexotherapy and alternating during the course: segmental in the lumbosacral zone - T3-5, V2Z, 25, 27, 31-34 and distant - V39, 40, 57, 60, 62, E36, VB 30, 34, 39, including vascular points RP6.9 F2.3; during the procedure, 6-8 points are used: 2-3 segmental and 4-5 distant, and the latter are chosen mainly on the side of the lesion, in particular pain. In the case of reflex syndromes, the selection of points is determined by the localization of pathological (muscle, vascular) manifestations, radicular - by the zone of innervation of the affected nerve roots, vasoreflex reactions - by the projection of the first lateral line of the back in combination with vascular points RP 6, 9, F 2, 3. In the area of each Alflutop is injected subcutaneously from the points, the treatment course includes 10 procedures, dispensed every other day.

Method description

The patient lies face down on the couch. After treatment with an antiseptic solution of the skin, Alflutop is injected subcutaneously in a volume of 0.2 ml into the area of 6-8 segmental, distant and "vascular" points, alternately selected from those presented below. In total, 2-3 segmental and 4-5 distant (including "vascular") points are stimulated for the procedure, and the distant points are selected mainly on the affected side.

If it is difficult to determine points by anatomical landmarks, the principle of dividing linear sections of the body into a certain number of equal segments is used. For this purpose, an individual cun is used - the distance between the skin folds of the 2nd phalanx of the middle finger when it is bent. Determined in men on the left hand, and in women - on the right, cun is on average 2.5-2.8 cm. Proportional "cun" is also used - the quotient of dividing the length of a particular area by its standard number of segments.

T3 - between the spinous processes of the IV and V lumbar vertebrae.

T4 - between the spinous processes of the II and III lumbar vertebrae.

T5 - between the spinous processes of the I and II lumbar vertebrae.

V2З - at the level of the interval between the spinous processes of the 2 and 3 lumbar vertebrae, 1.5 c outwards from the midline.

V25 - at the level of the interval between the spinous processes of the 4 and 5 lumbar vertebrae, 1.5 c outwards from the midline.

V27 - at the level of the interval between the spinous processes of the 1st and 2nd sacral vertebrae, 1.5 c outwards from the midline.

V31 - at the level of the spinous process of 1 sacral vertebra, 1 c outward from the midline, corresponding to the first sacral foramen.

V32 - at the level of the spinous process of the 2nd sacral vertebra, corresponding to the second sacral foramen.

V3З - at the level of the spinous process of the 3rd sacral vertebra, corresponding to the third sacral foramen.

VЗ4 - at the level of the spinous process of the 4th sacral vertebra, corresponding to the fourth sacral foramen.

V39 - at the lateral edge of the popliteal fold, medially from the tendon of the biceps femoris.

V40 - in the center of the popliteal fossa, outward from the popliteal artery.

V57 - in the center of the posterior surface of the lower leg, at the site of the transition of the gastrocnemius muscle to the Achilles tendon.

V60 - between the lateral malleolus (at the level of its center) and the Achilles tendon, in the depression.

V62 - under the lateral ankle, in a depression on the dorsal-plantar border of the foot.

E36 - 3 q below the lower edge of the patella, 1 cm outward from the tibial ridge.

RP6 - 3 quintals above the upper edge of the inner ankle.

RP9 - 2 c below the lower edge of the patella, at the postero-lower edge of the medial condyle of the tibia.

VB30 - in the upper-outer quadrant of the buttock, at the intersection of the line from the ischial tuberosity to the iliac crest and perpendicular to it from the greater trochanter.

VB34 - in a depression anteriorly and downward from the head of the fibula, 2 q below the edge of the patella.

VB 39 - at the anterior edge of the fibula, 3 q above the upper edge of the lateral malleolus of the lateral malleolus.

F2 - in the groove between the heads 1 and 2 of the metatarsal bones of the foot.

F3 - in the narrowest interval between the I and II metatarsal bones, proximal to their heads

Technically, the needle is inserted subcutaneously, injecting 0.2 of the drug into the area of each point. The treatment cycle consists of 10 procedures every other day.

EXAMPLES OF IMPLEMENTATION OF THE METHOD

EXAMPLE 1

Patient S., 36 years old, a loader, complained of pain in the lower back, outside of distinct irradiation (periodically - pain in the right buttock), accompanied by a feeling of excessive, emotionally unpleasant pulsation and chilliness in the feet.

Considers himself ill for about 3 years, when for the first time there was a moderate in severity low back pain. Exacerbations are annual, and short-lived, but the last relapse is more than 3 months.

Objectively: the condition and well-being are satisfactory, the consciousness is clear, from the side of the cranial nerves - no pathology. The lumbar lordosis is flattened, the movement of the trunk is difficult due to pain. Lasegue symptom on both sides at an angle of 60 degrees. In the motor and sensory areas - no disturbances Opel-Werbov's vascular foot test is positive on both sides.

X-ray images of the lumbosacral spine show flattening of the lumbar lordosis, convergence of the vertebral bodies, sclerosis of the endplates.

Thermography: zone of hyperthermia in the lumbosacral region and hypothermia along the lateral surface of the legs, with a temperature difference of 1.2 ° C. Rheovasography: restriction of pulse blood filling in the basins of the lower extremities, with RI of the legs 0.04 Ohm.

Conclusion: Lumbago in the phase of prolonged exacerbation with a leading neurovascular component.

The patient's treatment program included pharmacopuncture with the drug Alflutop, performed according to the rules of reflexotherapy - with alternate selection of 6-8 segmental and distant points from the given set. At the same time, in the case of a displacement of the "pattern" of pain, they acted on the points of the meridian close to this line

T3 - between the spinous processes of the IV and V lumbar vertebrae.

T4 - between the spinous processes of the II and III lumbar vertebrae.

T5 - between the spinous processes of the I and II lumbar vertebrae.

V2З - at the level of the interval between the spinous processes of the 2 and 3 lumbar vertebrae, 1.5 c outwards from the midline.

V25 - at the level of the interval between the spinous processes of the 4 and 5 lumbar vertebrae, 1.5 c outwards from the midline.

V27 - at the level of the gap between the spinous processes of the 1st and 2nd sacral vertebrae, 1.5 cc outwards from the midline.

V31 - at the level of the spinous process of 1 sacral vertebra, 1 c outward from the midline, corresponding to the first sacral foramen.

V32 - at the level of the spinous process of the 2nd sacral vertebra, corresponding to the second sacral foramen.

V3З - at the level of the spinous process of the 3rd sacral vertebra, corresponding to the third sacral foramen.

VЗ4 - at the level of the spinous process of the 4th sacral vertebra, corresponding to the fourth sacral foramen.

V39 - at the lateral edge of the popliteal fold, medially from the tendon of the biceps femoris.

V40 - in the center of the popliteal fossa, outward from the popliteal artery.

V57 - in the center of the posterior surface of the lower leg, at the site of the transition of the gastrocnemius muscle to the Achilles tendon.

V60 - between the lateral malleolus (at the level of its center) and the Achilles tendon, in the depression.

V62 - under the lateral ankle, in a depression on the dorsal-plantar border of the foot.

E36 - 3 q below the lower edge of the patella, 1 cm outward from the tibial ridge.

RP6 - 3 quintals above the upper edge of the inner ankle.

RP9 - 2 c below the lower edge of the patella, at the postero-lower edge of the medial condyle of the tibia.

VB30 - in the upper-outer quadrant of the buttock, at the intersection of the line from the ischial tuberosity to the iliac crest and perpendicular to it from the greater trochanter.

VB34 - in a depression anteriorly and downward from the head of the fibula, 2 q below the edge of the patella.

VB 39 - at the anterior edge of the fibula, 3 q above the upper edge of the lateral malleolus of the lateral malleolus.

F2 - in the groove between the heads 1 and 2 of the metatarsal bones of the foot.

F3 - in the narrowest interval between the I and II metatarsal bones, proximal to their heads.

Combination examples:

1 procedure - T4, V25 (two symmetrical points), V36 (right), V54 (right), V62 (two symmetrical points);

2 procedure - T4, V27 (two symmetrical points), V57 (right), VB34 (right), V60 (two symmetrical points).

3 procedure - V31 (two symmetrical points), F3 (two symmetrical points), aimed at reducing the severity of vascular manifestations.

The treatment course included 10 pharmacopuncture procedures with Alflutop, carried out every other day.

The result of the treatment was a significant improvement in the patient's condition, manifested in the relief of lumbar pain and vascular complaints.

Objectively: decreased pain in the algic zones, increased range of motion in the lumbar spine. Stop test Opel-Werbova - negative on both sides.

Thermography: reduction of thermoasymmetry in the lumbosacral and lower legs. Rheovasography: an increase in the pulse blood filling of the legs, manifested by an increase in RI by 32%.

Thus, the proposed scheme of pharmacopuncture with Alflutop provided a reduction in the subjective and objective manifestations of dorsopathy, allowing the result to be assessed as "significant improvement". At the same time, the noted positive vascular effect, uncharacteristic for the drug itself, can be explained by the influence of the reflex component of pharmacopuncture technology.

Example 2.

Patient K., 45 years old, a nurse, notes a prolonged, more than a month, recurrence of lumbar dorsopathy. The pain radiates from the lumbar region along the posterior-lateral right leg, to the foot, combined with numbness in this area.

Considers himself sick for more than five years; changes in the clinical picture, in particular, in the form of transformation of the pain pattern and stable numbness, occurred a year ago.

Objectively: the condition is satisfactory, the state of health is lower than satisfactory, the consciousness is clear, no pathology of the cranial nerves has been identified. Kyphoscolysis, the range of active movements in the lumbar spine is limited, more forward.

The knee reflexes are preserved and even. Left - a combination of a reduced Achilles reflex, hypesthesia along the back of the thigh and lower leg, as well as weakness of the extensor of the first toe. The Opel-Werbov stop test is positive on both sides.

MRI: 7 mm L5-S1 disc protrusion.

Thermography: hyperthermia at the segmental level, and hypothermia in the right leg, with a difference of 1.1 ° C. Rheovasography: decreased pulse blood filling of the lower extremities, with RI in the lower leg area 0.04 Ohm.

Conclusion: Prolonged exacerbation of S1 radiculopathy on the right with the dominance of the vascular component.

The ongoing treatment complex was enhanced by pharmacopuncture with Alflutop by alternately stimulating 6-8 symmetrical reflexotherapy points, selected from the following:

T3 - between the spinous processes of the IV and V lumbar vertebrae.

T4 - between the spinous processes of the II and III lumbar vertebrae.

T5 - between the spinous processes of the I and II lumbar vertebrae.

V2З - at the level of the interval between the spinous processes of the 2 and 3 lumbar vertebrae, 1.5 c outwards from the midline.

V25 - at the level of the interval between the spinous processes of the 4 and 5 lumbar vertebrae, 1.5 c outwards from the midline

V27 - at the level of the interval between the spinous processes of the 1st and 2nd sacral vertebrae, 1.5 c outwards from the midline

V31 - at the level of the spinous process of 1 sacral vertebra, 1 c outward from the midline, corresponding to the first sacral foramen.

V32 - at the level of the spinous process of the 2nd sacral vertebra, corresponding to the second sacral foramen.

V3З - at the level of the spinous process of the 3rd sacral vertebra, corresponding to the third sacral foramen.

VЗ4 - at the level of the spinous process of the 4th sacral vertebra, corresponding to the fourth sacral foramen.

V39 - at the lateral edge of the popliteal fold, medially from the tendon of the biceps femoris.

V40 - in the center of the popliteal fossa, outward from the popliteal artery.

V57 - in the center of the posterior surface of the lower leg, at the site of the transition of the gastrocnemius muscle to the Achilles tendon.

V60 - between the lateral malleolus (at the level of its center) and the Achilles tendon, in the depression.

V62 - under the lateral ankle, in a depression on the dorsal-plantar border of the foot.

E36 - 3 q below the lower edge of the patella, 1 cm outward from the tibial ridge.

RP6 - 3 quintals above the upper edge of the inner ankle.

RP9 - 2 c below the lower edge of the patella, at the postero-lower edge of the medial condyle of the tibia.

VB30 - in the upper-outer quadrant of the buttock, at the intersection of the line from the ischial tuberosity to the iliac crest and perpendicular to it from the greater trochanter.

VB34 - in a depression anteriorly and downward from the head of the fibula, 2 q below the edge of the patella.

VB 39 - at the anterior edge of the fibula, 3 q above the upper edge of the lateral malleolus of the lateral malleolus.

F2 - in the groove between the heads 1 and 2 of the metatarsal bones of the foot.

F3 - in the narrowest interval between the I and II metatarsal bones, proximal to their heads.

Combination examples:

1 procedure - T4, V25 (two symmetrical points), VB30 (right), V57 (right), V60 (two symmetrical points);

Procedure 2 - T4, V27 (two symmetrical points), E36 (right), V40 (right), V62 (two symmetrical points).

3 procedure - V32 (two symmetrical points), F2 (two symmetrical points), aimed at reducing the severity of vascular manifestations

Treatment was carried out by injecting Alflutop into the area of segmental, distant and "vascular" points of reflexotherapy in a volume of 0.2 ml per point. The impact consisted of 10 procedures, dispensed every other day

As a result of treatment, the intensity of pain decreased by 50%, objectively - an increase in the range of motion in the lumbar spine against the background of a decrease in the number of algic zones and some (insignificant) decrease in the area of hypoesthesia.

Thermography: the level of temperature asymmetry in the lumbar region and lower legs is reduced by 30%; rheovasography: simple pulse blood filling of the legs, with a rise in RI by 25%.

In general, the results obtained allow us to regard the achieved progress in the state as “significant improvement”.

The proposed method of treatment was applied to 100 patients aged 36 to 64 years with exacerbation of dorsopathies at the lumbosacral level, verified radiographically and / or tomographically.

Syndromologically, the prevalence of reflex over radicular disorders, established in 72 and 28 cases, was noted. The dominance of the vascular component of dorsopathy was confirmed by the results of the Goldflamm-Samuels and Opel-Werbov vascular tests.

For the vast majority of patients, a combination of hyperthermia in the projection of the lumbosacral spine and hypothermia in the lower extremities is typical. In 68 cases, a decrease in the pulse blood filling of the lower extremities was noted; according to Doppler sonography, circulatory disorders were observed in the posterior tibial and arteries of the dorsum of the foot.

The patients were divided into 2 randomized groups (each of 50 people): the main one, where pharmacopuncture was carried out according to the rules of reflexology, and the control one, using standard medical and orthopedic therapy. The treatment course in both groups consisted of 10 procedures, released every other day.

As a result, an improvement in the main group was noted in 74% of cases, and in the control group against - in 54%. Positive dynamics in the main group was manifested by a clear decrease in pain syndrome against the background of signs of reduction of vascular changes. In this group, a stable effect was revealed on average after 6.0, in the control group - after 8.1 procedures. Taking into account the performance of procedures every other day, a positive result in the groups was noted on average by 12 and 16.2 days of exposure.

Improvement of thermographic, rheographic and Doppler characteristics in the main group was observed in 75% of cases, in the comparison group - in 34%.

According to the follow-up analysis performed after a year, the recurrence of dorsopathy in the main group was noted in 22%, in the control group - in 31%.

Thus, on the basis of the study, the expediency of using the proposed method of pharmacopuncture, performed according to the rules of reflexotherapy, by the action of the drug Alflutop on the combination of segmental, distant and “vascular points” was substantiated. The explanation for this fact lies in the plane of potentiation of reflex and medicinal mechanisms.

This method makes it possible to increase the effectiveness of the treatment of patients with lumbosacral dorsopathy, promotes an early regression of the clinical manifestations of the disease and a reduction in the duration of treatment, leads to an improvement in the quality of life, helps to achieve prolongation of the therapeutic effect and slow down the progression of the disease.

Claims (1)

A method of treating patients with lumbosacral dorsopathy by injecting Alflutop into the tissues, characterized in that after pretreating the skin with an antiseptic solution, Alflutop is injected into the area of points selected according to the rules of reflexology and alternating during the course: segmental in the lumbosacral zone - Т3-5, V2З, 25, 27, V31-34 and distant points - on the lower extremities - V39, 40, 57, 60, 62, E36, VB 30, 34, 39, including vascular points RP6.9, F2.3 ; during the procedure, 6-8 points are used: 2-3 segmental and 4-5 distant, and the latter are chosen mainly on the affected side; in the case of reflex syndromes, the selection of points is determined by the localization of pathological manifestations, radicular - by the zone of innervation of the affected nerve roots, vaso-reflex reactions - by the projection of the first lateral line of the back in combination with vascular points RP 6, 9, F 2,3; 0.2 ml of Alflutop is injected subcutaneously into the area of each of the points, the treatment course includes 10 procedures, dispensed every other day.