SU1512625A1 - Method of treatment of patients with consequences of injures of spinal marrow - Google Patents
Method of treatment of patients with consequences of injures of spinal marrow Download PDFInfo
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Abstract
Изобретение относитс к медицине, в частности к нейрохирургии. Цель изобретени - ускорение сроков восстановлени двигательных функций у больного с травмой спинного мозга на уровне выше Д9 независимо от степени повреждений путем электростимул ции спинного мозга импульсами колоколообразной формы длительностью 1-5 мс с частотой заполнени 4-10 кГц, частотой следовани 8-12 Гц и напр жением 13-20 В непрерывно в течение 30-60 дней, при помощи эпидурально расположенных электродов вдоль боковых поверхностей сегментов спинного мозга в области по сничного утолщени , иннервирующего нижние конечности, ниже места повреждени . В качестве электрода служит пластина диаметром 0,2-0,3 мм и длиной, соответствующей размерам сегментов спинного мозга, иннервирующих нижние конечности. К электродам припа ны гибкие проводники, которые под кожей вывод т на боковую поверхность тела и размещают снаружи, фиксиру пластырем, подключают к электростимул тору. Лечение предлагаемым способом позвол ет добитьс восстановлени опороспособности конечностей их двигательной функции, восстановлени функции тазовых органов в сроки лечени , составл ющие около 60 дней.This invention relates to medicine, in particular to neurosurgery. The purpose of the invention - the acceleration timing recovery of motor function in patients with spinal cord injury at the level above D 9 regardless of the degree of damage by electrostimulation spinal cord tion bell-shaped pulses 1-5 msec duration at a frequency of 4-10 kHz padding, repetition frequency 8-12 Hz and a voltage of 13–20 V continuously for 30–60 days, using epidurally located electrodes along the lateral surfaces of the segments of the spinal cord in the region of the lumbar thickening innervating the lower limbs, below the site of injury eni A plate with a diameter of 0.2–0.3 mm and a length corresponding to the size of the segments of the spinal cord innervating the lower limbs serves as the electrode. Flexible conductors are soldered to the electrodes, which under the skin lead to the lateral surface of the body and are placed outside, fixed with a plaster, connected to an electrostimulator. The treatment by the proposed method makes it possible to achieve the restoration of the support function of the limbs of their motor function, the restoration of the function of the pelvic organs within the treatment time of about 60 days.
Description
Изобретение относитс к медицине, а именно к нейрохирургии.The invention relates to medicine, namely to neurosurgery.
Цель изобретени - ускорение сроков восстановлени двигательных функций у больного.The purpose of the invention is to accelerate the recovery of motor functions in a patient.
Способ осуществл етс следующим образом .The method is carried out as follows.
В зависимости от области повреждени спинного мозга у человека производ т л ми- нэктомию и эпидурально ввод т электроды. Располагают электроды таким образом, чтобы они легли по боковым поверхност м по сничного утолщени спинного мозга ниже места повреждени . В качестве электрода служит пластина диаметром 0,2--0,3 мм и длиной, соответствующей размерам сегментов спинного мозга, иннервирующих нижние конечности, проводники от электродов вывод т на боковую поверхность тела и размещают снаружи. На поверхности их фиксируют пластырем, после чего подключают электростимул тор. Стимул цию производ т непрерывно в течение 30-60 дней импульсами колоколообразной формы длительностью 1-5 мс, с частотой зaпoлнeни, 4-10 кГц, частотой следовани 8- -12 Гц и напр жением 13-20 В.Depending on the area of spinal cord injury in humans, a minectomy is performed and electrodes are inserted epidurally. The electrodes are positioned in such a way that they lie on the side surfaces along the lumbar spinal cord thickening below the injury site. A plate with a diameter of 0.2–0.3 mm and a length corresponding to the dimensions of the segments of the spinal cord innervating the lower limbs serves as an electrode; the conductors from the electrodes are brought to the lateral surface of the body and placed outside. On the surface they are fixed with a plaster, after which an electrostimulator is connected. The stimulation is carried out continuously for 30-60 days with pulses of a bell-shaped form with a duration of 1-5 ms, with a spill frequency of 4-10 kHz, with a repetition rate of 8-12 Hz and a voltage of 13-20 V.
Цель достигаетс за счет стимул ции спинального генератора шагани , расположенного в по сничном утолнаенни.The goal is achieved by stimulating a spinal pacing generator located in a lumbar area.
Максимальна длите.и носгь забо. юва- ни пос.че повреждени ciiiinHoi-o моз1 а составили по наблюдени . () /кп.Maximum length. And nosg zabo. Yuva- no village., damage to the ciiiinHoi-o brain was compiled by observation. () / CP.
сд tosd to
О) tsD СПO) tsd sp
Способ примен ют как при неполном перерыве , так и полном перерыве спинного мозга на уровне выше Дд.The method is applied both with an incomplete interruption and a complete interruption of the spinal cord at a level higher than DD.
Параметры режима нейтростимул ции получены от отечественного стимул тора «Стимул-1.The parameters of the neutrostimulation regime were obtained from the Stimul-1, a domestic stimulator.
Форма импульса выбрана колоколообраз- ной, т. е. той формы, котора приближена к естественной форме биопотенциала, частота заполнени 4-10 кГц обеспечиваетThe pulse shape is chosen to be bell-shaped, i.e., one that is close to the natural form of the biopotential, the filling frequency of 4-10 kHz provides
обнаружено: нижн параплеги , имеютс незначительные движени в проксимальных отделах рук, в дистальных отделах движени отсутствуют, двухсторонний рефлекс Бабинского. Болева гиперестези в зоне Cs корешков, переход ща в анестезию с уровн Сб по проводниковому типу на все виды чувствительности. Задержка мочи и кала.found: lower paraplegs, there are insignificant movements in the proximal parts of the arms, in the distal parts of the movement are absent, the Babinsky two-sided reflex. Painful hyperesthesia in the Cs zone of the roots, the transition to anesthesia from the S-level by conductor type to all types of sensitivity. Retention of urine and feces.
Произведена имплантаци электродовElectrode implantation performed
безболезненность стимул ции, частота еле- Ю эпидурально вдоль боковых поверхностейpainless stimulation, the frequency is barely epidural along the lateral surfaces
довани 8-12 Гц обеспечивает стимул цию, приближенную к частоте физиологического тремора. Максимальное приближение параметров стимул ции к естественным формамDoing 8–12 Hz provides stimulation close to the frequency of physiological tremor. Maximum approximation of stimulation parameters to natural forms
спинного мозга на уровне сегментов, соответствующих локализации локомоторного генератора щагани . После операции больному была начата электростимул ци спинногоspinal cord at the level of segments corresponding to the localization of the locomotor generator Shagan. After surgery, the patient was given electrostimulation of the spinal cord.
дает лучший эффект. Длительность им- «с мозга импульсами колоколообразной фор . , ..,.„.,,„1С.„л.ЖЛ lП П f П fgives the best effect. The duration of im- "from the brain pulses bell-shaped odds. , ..,. „. ,,„ 1С. „L.ZhL lP P f P f
мы длительностью 1,5 мс, с частотой следовани 10 Гц, напр жением 16 В. Частота заполнени 6 кГц.we have a duration of 1.5 ms, with a frequency of 10 Hz, a voltage of 16 V. The filling frequency is 6 kHz.
После непрерывной мес чной электро25After continuous monthly electric25
пульса выбрана по определению хронаксии, а амплитуда - по порогу возбуждени , что обеспечивает экономичность работы стимул тора .The pulse is chosen by definition of chronaxia, and the amplitude is selected according to the excitation threshold, which makes the stimulator work more efficiently.
Граничные значени силы тока, подаваемого на электроды, составл ют 16-24 мА. 20 стимул ции у больного по вились активные Длительность фронта нарастани 0,3-движени в левой ноге. Б правой ноге объемThe limiting values of the current supplied to the electrodes are 16-24 mA. 20 patient stimuli appeared active. The duration of the rise front was 0.3-movement in the left leg. B right leg volume
и сила движений была несколько меньше. Коленные и ахилловы рефлексы повышены, двухсторонний рефлекс Бабинского. Мочитс самосто тельно.and the strength of the movements was somewhat less. The knee and Achilles reflexes are enhanced, the Babinsky double-sided reflex. Mochits himself.
Пример 3. Больной 27 лет. Диагноз: последстви переломо-вывиха на уровне Се ушиба со сдавлением спинного мозга, спастический квадрипарез. Давность травмы два года. Данные объективного исследований: плеги в ногах, парез в руках, по вление пролежней до 14 дней, императивные позывы. Задержка мочеиспускани и стула. Во врем операции л минэктомии на уровне Сб обнаружена деформаци позвоночного канала со сдавлением спинногоExample 3. Patient 27 years old. Diagnosis: consequence of fracture-dislocation at the level of CE contusion with compression of the spinal cord, spastic quadriparesis. Prescription injury two years. Objective research data: plogs in legs, paresis in hands, the appearance of pressure sores up to 14 days, imperative urges. Delay urination and stool. During the operation of the minectomy at the Sb level, deformity of the spinal canal with compression of the spinal canal was detected.
правой - 2,5, диффузна гипотони мышц 35 мозга. Произведен спондилодез, импланта- голеней, более выраженна слева, в меньшейци электродов эпидурально вдоль боковыхright 2.5, diffuse hypotonia of the muscles 35 of the brain. Produced spinal fusion, implant-tibia, more pronounced on the left, in the smaller electrodes epidurally along the lateral
степени бедер. Коленные рефлексы высокие . Ахилловы рефлексы с клонусом стопы, отсутствуют брюшные рефлексы, двухсторон- НИИ рефлекс Бабинского, в левой ноге пирамидна гипертони . Умеренновыраженна гипестези болева , температурна тактильна с уровн Дэ по спинальному типу, выраженна гипестези по коршковому типу слева на уровне Ду-Да, справа Дв. Про2 ,0 мс и спада 0,7-3,0 мс.the extent of the hips. Knee reflexes high. Achilles reflexes with clonus of the foot, abdominal reflexes, bilateral Babinsky reflex, lack of hypertensive pyramid in the left leg. Moderate hypersensitivity of pain, temperature tactile from the level of De on the spinal type, pronounced hypesthesia on the root type on the left at the level of Du-Da, on the right. Pro2, 0 ms and a falloff of 0.7-3.0 ms.
Длина электродов равна длине по сничного утолщени и каждый раз подбираетс индивидуально.The length of the electrodes is equal to the length of the lumbar thickening and is individually adjusted each time.
Оценка мышечной силы производитс по определению нарастани биоэлектрической активности паретических мышц. В среднем по всем больным она увеличилась в 7,75 раза.Assessment of muscle strength is made by determining the increase in the bioelectrical activity of the paretic muscles. On average for all patients, it increased 7.75 times.
Пример 1. Больна 27 лет. Диагноз: состо ние после удалени менингиомы спинного мозга. Нижн параплеги . Нарушение функций тазовых органов. Давность заболевани полтора года. Данные объективного исследовани : в ногах объем движений полный, сила в левой ноге 2 балла, вExample 1. Sick 27 years. Diagnosis: condition after spinal cord meningioma has been removed. Lower paraplegia. Dysfunction of the pelvic organs. Disease duration a year and a half. Objective research data: full range of motion in the legs, strength in the left leg 2 points,
30thirty
4040
изведена имплантаци электродов вдоль боковых поверхностей спинного мозга эпидурально на уровне по сничного утолщени . Начата электростимул ци импульсами колоколообразной формы длительностью 5 мс, частотой заполнени 10 кГц, частотой следовани 12 Гц и напр жением 20 В. Прове- 50 дено 26 сеансов. Больна выписалась со значительным улучшением. Восстановилась опора на ноги, ходит самосто тельно, опира сь на палочку.The implantation of electrodes along the lateral surfaces of the spinal cord is epidurally reproduced at the level of lumbar thickening. An electrostimulation of bell-shaped pulses with a duration of 5 ms, a filling frequency of 10 kHz, a repetition frequency of 12 Hz, and a voltage of 20 V was started. 26 sessions were conducted. The patient was discharged with significant improvement. The support on the legs was restored, it walks independently, leaning on the wand.
Пример 2. Больной 54 года. Диагноз:Example 2. Patient 54 years old. Diagnosis:
поверхностей спинного мозга на уровне локомоторного генератора шагани . Начата электростимул ци импульсами колоколообразной формы длительностью 3,5 мс, частотой заполнени 4 кГц, частотой следовани 6 Гц и напр жением 12 В. Через полтора мес ца от начала стимул ции состо ние больного значительно улучшилось. По вились самосто тельные движени в ногах. л Производит произвольное сгибание до угла в 120°, сила сгибани в коленных суставах обеих ног 3-4 балла. Гипертонус не выражен. Свободное разгибание до угла 175-180°. Хорошо напр гает мышцы живота . Начал контролировать мочеиспускание. Пример 4. Больной, 21 год. Диагноз: последстви огнестрельного пулевого ранени позвоночника на уровне Д--Дв с полным повреждением спинного мозга. Спастический парапарез с нарушением функции тазовых органов. Давность травмы 3,5 года.surfaces of the spinal cord at the level of the locomotor generator of the step. An electrostimulation of bell-shaped pulses of 3.5 ms duration, a filling frequency of 4 kHz, a repetition frequency of 6 Hz and a voltage of 12 V was started. One and a half months later, the patient's condition improved significantly. Independent movements in the legs appeared. l Produces arbitrary flexion to an angle of 120 °, flexing force in the knee joints of both legs 3-4 points. Hypertonus is not pronounced. Free extension to an angle of 175-180 °. It strains the abdominal muscles well. Began to control urination. Example 4. Patient, 21 years old. Diagnosis: the consequence of a gunshot bullet wound of the spine at the level of D - Dv with complete damage to the spinal cord. Spastic paraparesis with dysfunction of the pelvic organs. The injury duration is 3.5 years.
закрыта травма шейного отдела позвоноч- 55 Объективно: нижние конечности в положении ника, сцепившейс переломо-вывих C,i-Csсгибани в тазобедренном и коленном суставах до 90°, тыльные сгибани в голеностопных суставах до 65°. Активные движени в нижних конечност х отсутствуют. Движесо сдавлением спинного мозга, квадрипле- ги , тазовые нарушени . Давность травмы 18 ч. При неврологическом обследованииinjury of the cervical spinal cord is closed 55 Objectively: the lower limbs in the position of the nickname, concatenated fracture-dislocation C, i-Css flexion in the hip and knee joints up to 90 °, dorsal flexion in the ankle joints up to 65 °. There is no active movement in the lower limbs. Movement of spinal cord compression, quadriplegia, pelvic disorders. The duration of injury is 18 hours. During neurological examination
обнаружено: нижн параплеги , имеютс незначительные движени в проксимальных отделах рук, в дистальных отделах движени отсутствуют, двухсторонний рефлекс Бабинского. Болева гиперестези в зоне Cs корешков, переход ща в анестезию с уровн Сб по проводниковому типу на все виды чувствительности. Задержка мочи и кала.found: lower paraplegs, there are insignificant movements in the proximal parts of the arms, in the distal parts of the movement are absent, the Babinsky two-sided reflex. Painful hyperesthesia in the Cs zone of the roots, the transition to anesthesia from the S-level by conductor type to all types of sensitivity. Retention of urine and feces.
Произведена имплантаци электродовElectrode implantation performed
эпидурально вдоль боковых поверхностей epidurally along lateral surfaces
спинного мозга на уровне сегментов, соответствующих локализации локомоторного генератора щагани . После операции больному была начата электростимул ци спинногоspinal cord at the level of segments corresponding to the localization of the locomotor generator Shagan. After surgery, the patient was given electrostimulation of the spinal cord.
мозга импульсами колоколообразной формозга импульсами колоколообразной ,„1С.„л.ЖЛ lП П f П f brain pulses of bell-shaped formosus of bell-shaped pulses, „1С.„ l.ZhL lP P f P f
мы длительностью 1,5 мс, с частотой следовани 10 Гц, напр жением 16 В. Частота заполнени 6 кГц.we have a duration of 1.5 ms, with a frequency of 10 Hz, a voltage of 16 V. The filling frequency is 6 kHz.
После непрерывной мес чной электромул ции у больного по вились активные жени в левой ноге. Б правой ноге объемAfter continuous month-long electromul- sation, the patient appeared active in the left leg. B right leg volume
00
0 0
поверхностей спинного мозга на уровне локомоторного генератора шагани . Начата электростимул ци импульсами колоколообразной формы длительностью 3,5 мс, частотой заполнени 4 кГц, частотой следовани 6 Гц и напр жением 12 В. Через полтора мес ца от начала стимул ции состо ние больного значительно улучшилось. По вились самосто тельные движени в ногах. л Производит произвольное сгибание до угла в 120°, сила сгибани в коленных суставах обеих ног 3-4 балла. Гипертонус не выражен. Свободное разгибание до угла 175-180°. Хорошо напр гает мышцы живота . Начал контролировать мочеиспускание. Пример 4. Больной, 21 год. Диагноз: последстви огнестрельного пулевого ранени позвоночника на уровне Д--Дв с полным повреждением спинного мозга. Спастический парапарез с нарушением функции тазовых органов. Давность травмы 3,5 года.surfaces of the spinal cord at the level of the locomotor generator of the step. An electrostimulation of bell-shaped pulses of 3.5 ms duration, a filling frequency of 4 kHz, a repetition frequency of 6 Hz and a voltage of 12 V was started. One and a half months later, the patient's condition improved significantly. Independent movements in the legs appeared. l Produces arbitrary flexion to an angle of 120 °, flexing force in the knee joints of both legs 3-4 points. Hypertonus is not pronounced. Free extension to an angle of 175-180 °. It strains the abdominal muscles well. Began to control urination. Example 4. Patient, 21 years old. Diagnosis: the consequence of a gunshot bullet wound of the spine at the level of D - Dv with complete damage to the spinal cord. Spastic paraparesis with dysfunction of the pelvic organs. The injury duration is 3.5 years.
5 Объективно: нижние конечности в положении сгибани в тазобедренном и коленном сусТаким образом, предлагаемый способ по сравнению с известным позвол ет восстановить двигательные функции у больного за счет активации локомоторного генеран и ниже. Мочеиспускание и дёфи- с тора шагани независимо от сроков давнос- каци непроизвольные.ти травмы и степени повреждени спинного мозга выше уровн Дэ, восстановить опороспособность конечностей, их двигательни в суставах тазобедренных 80-120°, коленных 80-140°, в голеностопных 65- 80°. Дальнейшие движени ограничены спас- тикой. Чувствительность отсутствует от уровБольному эпидурально введены электроды , расположенные таким образом, чтобы они легли по боковым поверхност х по сничного утолщени спинного мозга. Рана5 Objectively: the lower limbs in the flexion position in the hip and knee joint. Thus, the proposed method, in comparison with the known method, allows the patient to restore motor function by activating the locomotor generan and lower. Urination and déphor of the walker, regardless of the timing of involuntary injuries and the degree of damage to the spinal cord above the level of De, restore the support ability of the limbs, their movement in the hip joints 80-120 °, knee 80-140 °, in the ankle 65- 80 °. Further motions are limited by saving. Sensitivity is absent from the level of the patient. Epidurally inserted electrodes are arranged so that they lie on the lateral surfaces of the lumbar spinal cord thickening. Wound
закрыта обычным способом. В качестве элек- щие около 60 дней, тродов использованы пластины диаметром 0,3 мм и длиной, соответствующей размерам сегментов спинного мозга, иннервирую- щих нижние конечности. К электродам припа ны гибкие проводники, на которые на- j деты изолирующие их от м гких тканей катетеры с диамером, незначительно превышающим диаметр гибкого проводника. Гибкие проводники с надетыми на них катетераную активность, восстановить функции-тазовых органов в сроки лечени , составл юФормула изобретени closed in the usual way. As electrons for about 60 days, plates with a diameter of 0.3 mm and a length corresponding to the sizes of segments of the spinal cord innervating the lower limbs were used. Flexible conductors were attached to the electrodes, on which catheters insulating them from soft tissues were fitted with a catheter slightly larger than the diameter of the flexible conductor. Flexible conductors with catheteric activity put on them, to restore the functions of the pelvic organs in terms of treatment, was the formula of the invention
Способ лечени больных с последстви ми повреждени спинного мозга, включающий введение электродов в область задних столбов спинного мозга и проведение электростимул ции , отличающийс тем, что, с цеми провод т под кожей на боковую поверх-лью ускорени восстановлени двигательных ность тела и вывод т наружу. Снаружи их20 функций и функций органов, провод т элек- фиксируют пластырем. После этого подклю-тростимул цию импульсами колоколообраз- чают стимул тор. Стимул цию производ тной формы, длительностью 1-5 мс, с часто- непрерывно в течение 60 дней с частотойтой заполнени 4-10 кГц, частотой следо- следовани импульсов 10 Гц, частотой запол-вани 8-12 Гц, напр жением 13-20 В ненени 10 кГц, при длительности импульса25 прерывно в течение 30-60 дней, причем элек- 1-5 мс, и напр жением 12-15 В. Черезтроды располагают эпидурально, ниже Mecj 60 дней у больного значительно уменьши-та повреждени вдоль боковых поверхностей лась спастика. Больной стал удерживатьсегментов спинного мозга в области ПОЯС- МОЧУ и кал.ничного утолщени .A method for treating patients with consequences of spinal cord injury, which includes inserting electrodes into the posterior column of the spinal cord and conducting electrical stimulation, characterized in that, with cement, the body is accelerated and the body is accelerated to recover and out. Outside of their 20 functions and the functions of organs, they are held in place with a plaster. After that, the connection with the stimulation by impulses is bell-shaped by the stimulator. Stimulation of the derivative form, with a duration of 1–5 ms, with often continuously for 60 days with a filling frequency of 4–10 kHz, a pulse tracking frequency of 10 Hz, a filling frequency of 8–12 Hz, a voltage of 13–20 At 10 kHz, with a pulse duration of 25, it is discontinuous for 30-60 days, with an electrol of 1-5 ms, and a voltage of 12-15 V. The throats are located epidurally, the patient has significantly reduced damage along the lateral surfaces las spasticity. The patient began to hold the segments of the spinal cord in the area of the belts and urinary and calcareous thickening.
ного мозга выше уровн Дэ, восстановить опороспособность конечностей, их двигательщие около 60 дней, brain above the level of De, to restore the support ability of the limbs that drive them for about 60 days,
ную активность, восстановить функции-тазовых органов в сроки лечени , составл ющие около 60 дней, activity, restore pelvic organ functions within a treatment period of about 60 days,
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| SU874287782A SU1512625A1 (en) | 1987-07-21 | 1987-07-21 | Method of treatment of patients with consequences of injures of spinal marrow |
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| SU874287782A SU1512625A1 (en) | 1987-07-21 | 1987-07-21 | Method of treatment of patients with consequences of injures of spinal marrow |
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