RU2753120C1 - Method for treatment of patients with lymphostasis of lower extremities - Google Patents

Abstract

FIELD: medicine, physiotherapy.

SUBSTANCE: invention relates to medicine, namely to physiotherapy, physical rehabilitation, lymphology, vascular surgery. The effect of multi-channel electrical stimulation is carried out simultaneously on all muscles, applying two electrodes in the trapezius muscle area, two electrodes on both sides in the areas of the broadest muscle of back, quadriceps and biceps muscles of the thighs, anterior tibial and calf muscles of the shins. Additionally, two electrodes in the areas of the muscles of the feet from the back and plantar sides, bipolar pulse currents, with a trapezoidal envelope, the current is supplied, causing the work of all the muscles of the legs, with a current strength up to a moderate contraction of the muscles under the electrodes, a frequency of 20-120 Hz, sending and pausing for 2 seconds, respectively, the exposure time increasing by days from 10 to 20 minutes, daily, 4 days in a row. On the fifth day, shock wave therapy is performed on the leg area, with a frequency of 20 Hz, an energy density of 0.08 mJ/mm² on the first procedure, on subsequent procedures with a frequency of 15 Hz, an energy density of 0.12 mJ/mm², the number of blows in the leg area during the first procedure is 600-800 blows, during the next 1000-1200 blows, the diameter of the emitter head is 15 mm on the feet and shins and 25 mm in the thigh area. The general course is 15-20 daily procedures, depending on the patient's condition.

EFFECT: method provides an increase in effectiveness of treatment by creating the opportunity to cover many levels of the regulatory systems of the body, acting simultaneously on a large number of muscles in patients.

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Description

The method relates to medicine, namely to physiotherapy, physical rehabilitation, lymphology, vascular surgery.

The known "Method for the treatment of chronic lymphatic insufficiency of the lower extremities", based on catheterization of the lymphatic vessels of the patient's foot and the introduction of medications into them. At the same time, the photosensitizer "Photoditazin" is injected into the lymphatic vessel once at a dose of 0.4-0.8 ml, after which it is exposed to laser radiation with a wavelength of 660 nm, a radiation power density of 2.5 W / cm ² , an energy of 200 to 600 J for each zone of maximum edema of the lower extremities for 6-12 minutes. (Patent RU No. 2284838, 10.10.2006)

This method has limited application, since the introduction of a photosensitizer can cause allergic reactions, and also has many contraindications, for example, hypersensitivity to the drug, renal or hepatic failure, cardiovascular diseases in the decompensation phase, etc. body temperature and pain in the irradiation area. It is also possible to increase blood pressure in patients with diseases of the cardiovascular system. Photoditazine, when administered in therapeutic doses, also exhibits phototoxicity. So, in the first 28 hours after the administration of this drug, in case of violation of the light regime, patients may develop hyperemia and edema of open surfaces, as well as, possibly, an overdose, which is accompanied by shortness of breath, tachycardia, emotional excitement, alternating with depression.

There is another known "Method for the treatment of secondary lymphedema of the lower extremities", based on exposure to laser radiation with a wavelength of 0.6328 microns and the introduction of medications, characterized in that intravenous irradiation with a 1.2 mW laser with an exposure of 90 minutes and intravenous administration of medicinal preparations in the form of solutions: trental, actovegin, rheopolyglucin, vitamins of group B, C, xanthinol-nicotinate 0.15%, carried out daily in the amount of seven procedures per course. In this method, in addition, after intravenous laser irradiation and administration of medications, intra-articular irradiation of the knee joint is carried out, for this, an optical fiber with a diameter of 0.7 mm is introduced into the knee joint by puncture of the joint with a needle, followed by connection of a helium-neon laser with a power of 1.2 mW and irradiation with an exposure of 30 minutes every other day in the amount of seven procedures per course (Patent RU No. 2356587, publ. 27.05.2009).

This method has disadvantages, as in the previous method, due to the use of drugs, such as, for example, trental, which can cause headache, dizziness, anxiety, sleep disturbances, convulsions from the central nervous system. In this case, dermatological reactions are possible, in the form of skin hyperemia, sensations of "rush" of blood to the skin of the face and upper chest, edema, increased fragility of the nails. From the side of the digestive system, xerostomia, anorexia, intestinal atony are possible; and if patients have vascular pathology - tachycardia, arrhythmia, cardialgia, progression of angina pectoris, lowering blood pressure. Possible leukopenia, thrombocytopenia, pancytopenia, bleeding from blood vessels of the skin, mucous membranes, stomach, intestines, hypofibrinogenemia, visual impairment, scotoma, itching, skin flushing, urticaria, angioedema, anaphylactic shock, etc. Complications after intravenous irradiation are also possible: veins in the area where the catheter is inserted, hypotension or hypertension.

A known method for the treatment of lymphedema of the lower extremities, in which electrical impulses were supplied using two pairs of electrodes located in the groin area and on the posterior surfaces of both legs during bilateral stimulation or on the sole, the posterior region of the leg, thigh and in the groin area during regional stimulation. The current strength was selected individually until the patient felt characteristic light muscle contractions. The duration of the procedure was 20 minutes. The course is 10-15 sessions. (Matveev S., Naumenko E. Medicine and health. Article: Lymphedema of the lower extremities. Refoteka.ru. Https://www.bibliofond.ru/view.aspx?id=459738#text)

However, the known method is limited only by local influences; when it is implemented, there is no effect on the regulatory systems of the body, including the autonomic system, which limits its effectiveness.

The task is to create a system that allows you to improve lymphatic drainage of tissues due to a complex effect simultaneously on both limbs and along all the pathways of the lymph flow, including the trunk.

The technical result is an increase in the effectiveness of treatment by creating an opportunity to cover many levels of the body's regulatory systems, simultaneously acting on a large number of muscles in patients.

To achieve a technical result in the method of treating patients with lymphostasis of the lower extremities by multichannel electrical stimulation, the effect is carried out simultaneously on all muscles, applying two electrodes in the trapezius muscle, two electrodes on both sides in the areas of the latissimus muscles of the back, quadriceps and biceps muscles of the thighs, anterior tibial and calf muscles of the legs, additionally two electrodes in the areas of the muscles of the feet from the dorsum and plantar sides, bipolar-impulse currents, from the trapezoidal envelope, the current was supplied, creating the work of all muscles of the legs in the rhythm of a "step", current strength until moderate muscle contraction under electrodes, with a frequency of 20-120 Hz, sending and a pause of 2 s, respectively, the exposure time increasing from 10 to 20 minutes every day, every day, 4 days in a row, on the fifth day, shock wave therapy was performed on the leg area, with a frequency 20 Hz, energy density 0.08 mJ / mm ² in the first procedure, in subsequent procedures with a frequency of 15 Hz, tightly with an energy of 0.12 mJ / mm ^{2 the} number of blows in the leg area in the first procedure 600-800 blows, in the next 1000-1200 blows, the diameter of the emitter head is 15 mm on the feet and legs and 25 mm in the thighs, labile, general course 15 -20 daily procedures, depending on the patient's condition.

The proposed method for the treatment of patients with lymphostasis of the lower extremities is carried out as follows.

Multichannel electrical stimulation was performed simultaneously on all muscles. In this case, in the area of the trapezius muscle, two electrodes were applied in the projection of the motor zones, where the trunk of the sympathetic nervous system is also located. Then, two electrodes were inserted from both sides in the areas of the latissimus dorsi muscles, capturing the projection of the kidneys and adrenal glands to improve sympatho-adrenal interactions.

It is known that catecholamines contribute to the regulation of water homeostasis due to direct norepinephrine stimulation of sodium reabsorption, thereby maintaining a constant volume of extracellular fluid and improving lymphatic drainage throughout the human body, creating a vector of adequate unidirectional dehydration. In this case, the trapezius and both latissimus muscles are respiratory, and the electrodes located on the broadest muscles of the back reflexively affect the diaphragm, thus improving blood suction to the heart, which, in general, improves lymphatic drainage.

Then, on both sides, two electrodes were applied in the areas of the quadriceps and biceps muscles of the thighs, the anterior tibial and gastrocnemius muscles of the lower legs, in addition, two electrodes were applied in the areas of the muscles of the feet on the back and plantar sides. The direct results of such electrostimulating effects were an increase in the rate of lymph outflow, removal of spasm of peripheral arteries, normalization of venous outflow parameters, anti-edema and anti-inflammatory effect, improvement of metabolism and regeneration of various body tissues, reduction of sclerosis and tissue fibrosis, as well as blockade of pathological pain impulses.

The most physiological bipolar-pulse currents were used, with a trapezoidal envelope, resembling the shape of a pulse in the Ranvier interception zone, with a frequency of 20-120 Hz, a burst and a pause of 2 s, respectively.

All electrodes were connected to the channels of the apparatus in such a way that the supply of current was carried out, creating the work of all leg muscles in the rhythm of a "step", while the flexor and extensor muscles of the legs contracted in antiphase. The imitation of the step sequentially activated the lymphovenous-muscle "pumps" of the lower extremities, creating their physiological relationship. In this case, the lymphovenous-muscle "pumps" play the role of the peripheral heart, which helps to avoid gravitational reflux during muscle diastole. The rhythmic contraction of the leg muscles facilitated blood flow from the superficial vein system into the deep veins and also normalized lymphatic drainage.

The time of exposure to multichannel electrical stimulation, taking into account the presence of such a complex pathology, was increased gradually, with an increase in days from 10 to 20 minutes for each patient. The procedures were carried out daily, 4 days in a row. On the fifth day, shock wave therapy was performed on the leg area, under the action of which vasodilation of blood vessels occurred, due to the formation of biologically active substances, including nitric oxide, which, in general, provided anti-inflammatory, anti-exudative and defibrosing effects, and provided a rapid analgesic effect and also stimulated tissue regeneration. The technique was carried out with a frequency of 20 Hz in the first procedure, and in subsequent procedures - with a frequency of 15 Hz.

To limit the depth of penetration of shock impulses into tissues in order to avoid their damage, a low energy density of 0.08 mJ / mm ^{2 was used} in the first procedure, and in subsequent procedures, an energy density of 0.12 mJ / mm ^{2 was used.} the procedure was 600-800 strokes, and on subsequent - 1000-1200 strokes.

On the feet and legs we used a radiator with a head diameter of 15 mm and in the thigh area - 25 mm. The procedures were carried out according to the labile technique. The general course was 15-20 procedures, depending on the patient's condition.

All operating characteristics of the method, such as, for example, the frequency range, the number of blows in the leg area, the sequence and duration of the procedures were established experimentally. In the process of implementing the method, a multichannel electrostimulator was used according to the patent RU No. 2128529 dated 06/11/1998, which has all the necessary range of technical characteristics.

The method of treating patients with lymphostasis of the lower extremities is illustrated by examples.

Example 1. Patient "D", 60 years old, was observed with a diagnosis of Lymphostasis of the lower extremities, stage II-III. Anamnesis: 2 years ago she suffered polytrauma of the legs and pelvis, received surgical and conservative treatment. During the last month, lymphodema developed on both sides in the areas of the foot, lower leg and lower third of the thigh, which was accompanied by swelling of the legs, cold extremities, pallor of the skin, fatigue when walking, limited movement, and recurrent pain in the legs.

Patient "D", against the background of the necessary drug therapy and wearing compression hosiery, was prescribed additional treatment according to our proposed method.

The procedure was performed with the patient lying on a couch, under the lumbar and knee joints there was a soft roller to give the body and legs a physiological position. All stimulation electrodes were fixed with elastic bandages. Multichannel electrical stimulation was performed simultaneously on all muscles by placing two electrodes in the area of the trapezius muscle. The next two pairs of electrodes were fixed in the areas of the latissimus dorsi muscles, symmetrically positioning them in relation to each other. After that, two electrodes were fixed with bandages on both sides in the areas of the quadriceps and biceps muscles of the thighs, the anterior tibial and gastrocnemius muscles of the legs, as well as in the areas of the anterior tibial and gastrocnemius muscles. Additionally, two electrodes were placed in the areas of the muscles of the feet on the back and plantar sides.

A bipolar-pulse current with a trapezoidal envelope, for example, from the device "Miomodel-10", was applied until moderate muscle contraction under the electrodes. A frequency of 20–120 Hz was used, a message and a pause of 2 s were selected, respectively. In the first procedure, the time was 10 minutes. Then the exposure time increased by day up to 20 min. The procedures were carried out daily, 4 days in a row.

On the fifth day, shock wave therapy was performed, for example, from the Piezon-300 apparatus. In the first procedure, they were exposed with a frequency of 20 Hz, an energy density of 0.08 mJ / mm ² in the first procedure, and the number of blows in the leg area was 600 blows, in the next three procedures - 1000 blows, with a frequency of 15 Hz, an energy density of 0.12 mJ / mm ² . On the feet and legs, a radiator with a head diameter of 15 mm was used, and in the area of the thighs - 25 mm. The procedure was performed by moving the emitter labilely along the affected leg. The general course of treatment included 15 daily procedures, consisting of 12 multichannel electrical stimulation procedures and three shock wave therapy procedures.

After the course of treatment in patient D, with linear measurements in the area of the left and right legs, the volume of tissues, respectively, decreased in the lower third of the thighs by 23-25%, in the upper middle third of the legs - by 27-28%, at the level of the feet - by 28- 32%. At the same time, the pain and cramps became less, the range of motion in the leg increased, and the swelling and fatigue of the legs became less.

Example 2. Patient "R", 52 years old, was observed with a diagnosis of Lymphostasis of the lower extremities, stage 2. History: 6 months ago suffered frostbite of the legs and feet. After thermal injury, lymphedema developed in the feet and legs. During the first four months, it occurs intermittently only after physical exertion. During the fifth and sixth months, there were constant swelling of the legs and feet, accompanied by numbness and parasthesia of the toes, limitation of movement in the legs, recurrent pain and a feeling of heaviness in the feet. Clinical manifestations were more pronounced in the area of the right leg.

Patient "R", while wearing compression hosiery and standard drug therapy, was treated according to our proposed method. At the same time, multichannel electrical stimulation was performed simultaneously on all muscles for 4 days, and on the fifth day, shock wave therapy was performed on the leg area, with a frequency of 20 Hz, an energy density of 0.08 mJ / mm ² in the first procedure, and in subsequent procedures with a frequency of 15 Hz. with an energy density of 0.12 mJ / mm ² , the number of strokes in the leg area in the first procedures was 800 strokes, in subsequent procedures - 1200 strokes, the diameter of the emitter head was 15 mm on the feet and legs and 25 mm in the thigh area, labile, the total course was 20 procedures: 16 procedures of electrical stimulation, 4 procedures of shock wave therapy.

After the course of treatment in patient "R" with linear measurements of the left and right legs, the volume of tissues, respectively, decreased in the upper third of the lower leg - by 42-37%, in the lower third of the lower leg - by 40-35%, at the level of the foot by 34-30%. At the same time, parasthesias, numbness and pain became less, the range of motion in the legs increased, the swelling became less, the cramps disappeared, and the fatigue of the legs when walking became less.

In both of the above cases, there were no relapses during follow-up up to 8 months.

The proposed method for treating patients with lymphostasis of the lower extremities increases the effectiveness of treatment, allows to achieve better clinical results, covers many levels of the body's regulatory systems, simultaneously acting on a large number of muscles in patients, which, in general, improves the state of the lymphatic drainage system and ensures long-term remission of the disease.

Claims (1)

A method of treating patients with lymphostasis of the lower extremities, characterized by multichannel electrical stimulation, in which the effect is carried out simultaneously on all muscles, applying two electrodes in the area of the trapezius muscle, two electrodes on both sides in the areas of the latissimus muscles of the back, quadriceps and biceps muscles of the thighs, anterior tibial and calf muscles of the legs, two electrodes are additionally installed in the areas of the muscles of the feet from the dorsum and plantar sides, by bipolar impulse currents, from the trapezoidal envelope, and the current is supplied, creating the work of all muscles of the legs, by the current strength until the muscles under the electrodes are contracted, the frequency 20-120 Hz, sending and a pause of 2 s, respectively, the exposure time increasing from 10 to 20 minutes every day, every day, 4 days in a row, on the fifth day, shock wave therapy is performed on the leg area, with a frequency of 20 Hz, density energy 0.08 mJ / mm ² in the first procedure, in subsequent procedures with a frequency of 15 Hz, energy density 0.12 mJ / mm ² , the number of impulses in the leg area during the first procedure 600-800 impulses, for the next 1000-1200 impulses, the emitter head diameter is 15 mm on the feet and legs and 25 mm in the thigh area, labile, the general course is 15- 20 daily procedures, depending on the patient's condition.