RU2385169C1 - Method of treating children with posttraumatic limb injures in postoperative period - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention is related to medicine and aims at treating the children with posttraumatic limb injures in postoperative period. The patient is exposed to low-frequency (1-2 Hz) pulse currents supplied to the patient's body from the device "Lymphavision" with using 2 electrodes placed along the greatest perimetre around an injury area with respect to the lymph flow ducts. The exposure requires current strength 3 to 15 mA prescribed individually for each patient to sensation of distinctive slight visible muscular reductions. The exposure time is 8-10 min for a course of 6-10 daily procedures.

EFFECT: method provides antiinflammatory action, reduced pain syndrome, relieved spasm of peripheral arteries, normalised venous outflow, improved supply and regeneration of postoperative tissues, reduced sclerosing and fibrosis of tissues.

3 ex

Description

The present invention relates to medicine, in particular to pediatrics, namely to microsurgery, and can be used in medical institutions for the treatment of children with post-traumatic injuries of the limbs in the postoperative period.

Currently, the treatment of children with post-traumatic injuries of the extremities in the postoperative period is complex in nature, aimed primarily at treating post-traumatic and postoperative edema and hematomas, detonation and elimination of stagnation in tissues, accelerating scarring of damage to various tissues (ligaments, tendons and muscles), fight with inflammation in the tissues, accelerating interstitial metabolism, relieving pain, restoring the range of motion of a damaged limb, activating the processes of conducting nerve momentum of correction vascular disorders, resulting in a significant reduction in terms of hospitalization and rehabilitation further.

Known methods for treating children with post-traumatic injuries of the extremities in the postoperative period, which include: therapeutic immobilization (operative - internal osteosynthesis with metal structures and external - devices for percutaneous fixation with knitting needles and rods; non-operative - gypsum, starch, adhesive plasters, scarf, bandage and porous) therapy (antibiotics, desensitizing drugs, painkillers, topical application of dressings with various ointments), treatment complexes izkultury massage muscles and healthy limbs, segmental-reflex zone massage drain above and below the injury site, different methods of physiotherapy and spa treatment.

However, the main disadvantages of these methods of treatment are the excessive duration of the treatment with simultaneous significant physical exertion, their repeated frequency, which requires the use of considerable volitional efforts on the part of the child, and this, in turn, entails rapid fatigue and the occurrence of undesirable negative reactions with side of the child himself. As a result, the degree of effectiveness of the treatment is reduced.

There are also known methods of treating children with post-traumatic injuries of the extremities in the postoperative period by applying physical factors, such as in the early period of the disease, magnetic therapy on the area of damage with the aim of anti-edematous anti-inflammatory action, reduce pain. Inductors or solenoids are placed transversely or along the limb, magnetic induction 10-12 MT, duration 10-15 minutes, daily, for a course of 10-12 procedures.

In order to accelerate metabolic processes, unload tissue from venous stasis and lymph, ultraviolet irradiation of the affected limb with fields, 1-4 biodoses, daily or every other day, for a course of treatment of 5-6 exposures; ultraviolet irradiation of the segmental zone (lumbar or collar) of 1-2 biodoses, after 2-3 days, for a course of treatment of 3-4 exposures (Umarova Kh.T., Karachevtseva T.V. Physiotherapy in pediatrics, 1993). However, with these treatment options, we do not achieve the desired decongestant and anti-inflammatory effect, and when exposed to an affected limb, it is technically possible to carry out this only under dressing conditions. The disadvantage of these methods is their least effectiveness decongestant action.

Closest to the technical nature of the proposed method is a method of treatment in the postoperative period of children with post-traumatic injuries of the limbs, based on the use of rectangular and diadynamic currents, which consists in electrical stimulation of the damaged limb. The procedures are carried out from the Stimul-1 apparatus, frequency 50 Hz, duration of current deliveries 10 s, pauses - 20 s, current strength until a pronounced, painless vibration is felt, lasting 5-10 minutes, daily or every other day, course 10-15 procedures or electrical stimulation using the Amplipuls-4.5 apparatus, where a non-rectified mode is used, type II of operation, modulation frequency 30 Hz, depth 75-100%, duration of parcels 2-3 s, duration of the procedure 4-12 min. The current strength is selected individually until a feeling of vibration. The course of treatment is 10-15 procedures (Umarova Kh.T., Karachevtseva T.V. Physiotherapy in pediatrics, 1993).

The disadvantages of this method are the possibility of addiction through the use of constant frequencies, the lack of the most accurate impact on the pathological zone, the possibility of an irritating effect under the electrodes and the development of allergic reactions is not ruled out, and the negative reaction (tearfulness, fear) in a child cannot be completely ruled out on this kind of impact.

The technical result of the proposed method is to increase the effectiveness of treatment, reduce pain, improve motility of the lymphangion, increase the speed of outflow of lymph, relieve spasm of the peripheral arteries, normalize the parameters of venous outflow, decongestant and anti-inflammatory effects, improve nutrition and regeneration of various body tissues, reduce sclerosis and fibrosis of tissues , as well as the blockade of pathological impulses, reducing the duration of hospitalization and the timing of further rehabilitation.

The specified technical result is achieved by exposing the patient to low-frequency pulsed currents of 1-2 Hz from the Limfavijin apparatus, supplied to the patient’s body using two electrodes located along the largest perimeter around the lesion area relative to the lymph flow paths, with a current strength of 3 to 15 mA individually for each patient to the sensation of characteristic lung muscle contractions, exposure time of 8-10 minutes, per course of 6-10 daily procedures.

The difference between the apparatus "Limfavizhin" is the selective selectivity of its action. Experimentally, artificial signals were created that were specially selected to stimulate smooth muscle in the walls of lymphatic vessels and veins. Reproducible impulses of the autonomic nervous system are sent selectively to the smooth muscles of the lymphatic and venous vessels. The indicated type of current for influencing the lymphatic and venous systems has not been used until recently due to the lack of the necessary technical capabilities. In the process of creation and testing, the whole range of knowledge of the anatomy and physiology of the lymphatic and venous systems was taken into account, which was reflected in the methods of applying electrodes and therapeutic programs.

DESCRIPTION OF THE METHOD OF TREATMENT

When performing the method, the patient is in a supine position. We use flexible rubber electrodes with viscose gaskets moistened with water, size 9 × 10 cm and filter paper located on the gaskets, providing better contact of the electrode with the body and performing hygienic functions. Fixation of the electrodes is carried out using special elastic bands. A pair of electrodes is placed on the injured limb, located along the largest perimeter around the lesion area (or above the place of the gypsum langeta) relative to the lymph flow paths. The impact is carried out by pulsed currents of low frequency up to 2 Hz, acting on the smooth muscles of the walls of the lymphatic and venous vessels, the current strength is from 3 to 15 mA individually for each patient to the sensation of characteristic light muscle contractions, the duration of the procedure is 8-10 minutes per 6- course 10 daily treatments.

EXAMPLES OF IMPLEMENTING THE METHOD

Example 1

Maria M., 6 years old, was admitted to the microsurgical department of Children's Clinical Hospital No. 13 named after MF Filatova with a diagnosis of a cut wound of the 3rd finger of the left hand with damage to the flexor tendon.

Complaints on admission: pain in the area of 3 fingers.

Anamnesis of this disease: the child fell on his left hand and cut himself with glass.

Local status: in the area of the palmar surface of the middle phalanx of the 3rd finger of the left hand, the sutured wound is about 2 cm in size, the swelling is moderate, there are no active movements (flexion) in the 3rd finger. The finger is in the most extended position. The edges of the wound are uneven.

Operation: primary surgical treatment of the wounds of the 3rd finger of the left hand. Primary suture of the tendon of the deep flexor of the 3rd finger of the left hand.

After surgery, upon examination, the child's condition is satisfactory, complaints of pain in the region of the 3rd finger, not fever. Local status: severe swelling of the hand and fingers. Seams are wealthy, there is no detachable. An aseptic dressing with levomekol, a plaster cast to the level of the middle third of the forearm was applied.

While in the department, the girl received: cefazolin 500 thousand × 3 times a day; nystatin 500 thousand × 3 times a day; suprastin 1 t. × 2 times a day; vasoactive electrical stimulation of the affected limb.

Before the first procedure was carried out:

- measurement of the circumference of a damaged and healthy limb in symmetrical areas: n / a forearm on a healthy limb - 12 cm, on the damaged -12.5 cm;

- assessment of the state of the microvasculature by laser Doppler flowmetry on the damage side and symmetric to it revealed: ↑ V at 3.1% and ↓ SO2 at 11.1% on the side of the injury, ↑ V at 2.8% and ↑ SO2 at 6.5 % on the symmetric side.

Vasoactive electrical stimulation of the affected limb was carried out from the apparatus "Limfavizhin". On the upper left limb, two electrodes are located along the largest perimeter from each other relative to the paths of the lymph flow (one is distal to the inner surface of the forearm above the longet, the other proximal to the posterior surface of the shoulder in the upper third). We use flexible rubber electrodes with viscose gaskets moistened with water, size 9 × 10 cm and filter paper located on the gaskets, providing better contact of the electrode with the body and performing hygienic functions. Fixation of the electrodes is carried out using special elastic bands. The impact is carried out by pulsed currents of low frequency up to 2 Hz, the current strength during the procedure was 5 mA, with its gradual increase by the end of the course to 10 mA to the sensation of characteristic light visible muscle contractions, the duration of the procedure was 10 minutes, for a course of 8 procedures.

- after the first procedure, when measuring the circumference of a damaged and symmetrical limb, a decrease in the difference in circumference by 0.4 cm is noted.

The tolerability of the procedures is satisfactory, did not present complaints:

- at the end of the course, the circumference of the damaged limb corresponded to or approached the circumference of a symmetrical limb

- assessment of the state of the microvasculature by laser flowmetry in dynamics revealed an improvement in indicators in the form of a slight increase in blood volume (↑ V) and a decrease in saturation (↓ SO2) on the side of the injury. On the symmetrical side, the indicators approached the norm.

Example 2

Kirill S., 7 years old, was admitted to the microsurgical department of Children's Clinical Hospital №13 named after MF Filatova with a diagnosis of chronic injury to the flexor tendon of the 5th finger of the right hand.

Complaints at admission: restriction of flexion of the 5th finger of the right hand. Anamnesis of this disease: 6 months ago, I cut the 5th finger of the right hand with a knife.

Local status: in the area of the middle phalanx of the 5th finger of the right hand scar. Limited flexion in the joint of the finger.

Operation: the first stage of tendon plastic surgery of the deep flexor of the 5th finger of the right hand.

After surgery, upon examination, the child's condition is satisfactory, complaints of pain in the area of the 5th finger, not fever. Local status: severe swelling of the hand and fingers. Seams are wealthy, there is no detachable. An aseptic dressing with levomekol, a plaster cast to the level of the middle third of the forearm was applied.

While in the department, the child received: cefazolin 500 thousand × 3 times a day; suprastin 1/2 t. × 2 times a day; vasoactive electrical stimulation of the affected limb.

Before the first procedure was carried out:

- measurement of the circumference of a damaged and healthy limb in symmetrical areas: n / a forearm on a healthy limb - 13 cm, on the damaged - 15 cm;

assessment of the state of the microvasculature by laser Doppler flowmetry on the damage side and symmetrical to it revealed: ↑ V by 3.6% and ↓ SO2 by 12.1% on the side of the injury, ↑ V by 2.9% and ↑ SO2 by 6.2% on the symmetrical side.

Vasoactive electrical stimulation of the affected limb was carried out from the apparatus "Limfavizhin". On the upper right limb, two electrodes are placed along the greatest perimeter from each other relative to the paths of the lymph flow (one is distal to the inner surface of the forearm above the longet, the other proximal to the posterior surface of the shoulder in the upper third). We use flexible rubber electrodes with viscose gaskets moistened with water, size 9 × 10 cm and filter paper located on the gaskets, providing better contact of the electrode with the body and performing hygienic functions. Fixation of the electrodes is carried out using special elastic bands. The effect is carried out by pulsed currents of low frequency up to 2 Hz, the current strength during the procedure was 7 mA, with its gradual increase by the end of the course to 10 mA until the sensation of characteristic light visible muscle contractions, the duration of the procedure was 10 minutes, for a course of 8 procedures.

- after the first procedure, when measuring the circumference of a damaged and symmetrical limb, a decrease in the difference in circumference by 1.5 cm is noted.

Tolerance of the procedures is satisfactory, no complaints.

- at the end of the course, the circumference of the damaged limb corresponded to the circumference of a symmetrical limb;

- assessment of the state of the microvasculature by laser flowmetry in dynamics revealed an improvement in indicators in the form of a slight increase in blood volume (↑ V) and a decrease in saturation (↓ SO2) on the side of the injury. On the symmetrical side, the indicators approached the norm.

Example 3

Anton K., 14 years old, was admitted to the microsurgical department of Children's Clinical Hospital No. 13 named after MF Filatova with a diagnosis of a cut wound of the lower third of the left lower leg. Complaints at admission: pain in the left leg. Anamnesis of this disease: cut with a knife. Local status: in the region of the lower third of the left lower leg, a sutured wound about 3 cm in size, moderate edema. The edges of the wound are uneven. Operation: primary surgical treatment of the wound. Suturing.

After surgery, upon examination, the child's condition is satisfactory, complaints of pain in the postoperative area, not fever. Local status: there is a pronounced swelling of the foot and lower third of the left lower leg. The sutures are wealthy, there is no discharge. An aseptic dressing with levomekol is applied.

While in the department, the child received: cefazolin 500 thousand × 3 times a day; suprastin 1/2 t. × 2 times a day; vasoactive electrical stimulation of the affected limb.

Before the first procedure was carried out:

- measurement of the circumference of the damaged and healthy limb in symmetrical areas: on a healthy limb at the level of the middle third of the foot - 20 cm, the lower third of the lower leg - 18 cm; on the injured limb 21 and 20 cm, respectively;

- assessment of the state of the microvasculature by laser Doppler flowmetry on the damage side and symmetrical to it revealed: ↑ V by 2.9% and ↓ SO2 by 10.8% on the side of the injury, ↑ V by 2.1% and ↑ SO2 by 4.8 % on the symmetric side.

Vasoactive electrical stimulation of the affected limb was carried out from the apparatus "Limfavizhin". Two electrodes are located on the lower left limb along the greatest perimeter from each other relative to the paths of the lymph flow (one distally to the plantar surface of the foot, the other proximal to the anterior surface of the upper third of the leg). We use flexible rubber electrodes with viscose gaskets moistened with water, size 9 × 10 cm and filter paper located on the gaskets, providing better contact of the electrode with the body and performing hygienic functions. Fixation of the electrodes is carried out using special elastic bands. The impact is carried out by pulsed currents of low frequency up to 2 Hz, the current strength during the procedure was 10 mA, with its gradual increase by the end of the course to 13 mA to the sensation of characteristic light visible muscle contractions, the duration of the procedure was 10 minutes, for a course of 8 procedures.

- after the first procedure, when measuring the circumference of a damaged and symmetrical limb, a decrease in the difference in circumference on the foot is 0.5 cm, on the lower leg - 1.0 cm.

Tolerance of the procedures is satisfactory, no complaints.

- at the end of the course, the circumference of the damaged limb at the foot level corresponded to the circumference of the symmetrical limb, at the lower leg level, the difference in circumference of the damaged and symmetrical limb was 0.5 cm;

- assessment of the state of the microvasculature by laser flowmetry in dynamics revealed an improvement in indicators in the form of a slight increase in blood volume (↑ V) and a decrease in saturation (↓ SO2) on the side of the injury. On the symmetrical side, the indicators approached the norm.

The proposed method was first used in the postoperative period of treatment in 40 children aged 5 to 17 years with various pathologies: a cut wound of the 3rd finger of the left hand with damage to the flexor tendon; cut wound of the lower third of the left lower leg; cut wound of the lower third of the left forearm of the flexors of the 2nd finger, tendon of the long flexor of the 1st finger, radial artery; condition after an explosive injury of the right hand and others on the basis of the microsurgery department of Children's Clinical Hospital №13 named after N.F. Filatova.

As a result of the application of the proposed method of treatment in children with post-traumatic injuries of the extremities, a favorable effect of vasoactive electrical stimulation on the clinical course of the disease was observed, a pronounced anti-edema effect (according to anthropometric data) - the difference in the circumference of the damaged and symmetrical limb on average after the first procedure decreased by 0.5-2 cm by the end of the course;

anti-inflammatory effect, reduction of pain, relief of peripheral arterial spasm, normalization of venous outflow, improvement of nutrition and tissue regeneration in the postoperative area, reduction of tissue sclerosis and fibrosis. According to laser Doppler flowmetry, there are differences in the indicators of microcirculation before surgical treatment compared with the norm, and the operation, being a traumatic injury, also has a negative effect on the indicators of microcirculation and tissue absorption of oxygen. Prior to the beginning of exposure to vasoactive stimulation from the Limfavizhin apparatus, there was an increase in blood circulation in the microvasculature both on the damage side and on the symmetrical limb as a result of post-traumatic inflammation, which, in turn, was accompanied by a decrease in tissue oxygenation on the side of the injury, and on the symmetric increased oxygenation. After the course of treatment with the proposed method, there was a tendency to normalize microcirculation by eliminating post-traumatic inflammation, congestion, and also accelerating the course of reparative processes. As a result of the course, the periods of hospitalization (on average by 5-6 days) and further rehabilitation of children with post-traumatic injuries of the limbs were significantly reduced.

Claims (1)

A method of treating children with post-traumatic injuries of the extremities in the postoperative period, including exposure to low-frequency pulse current, characterized in that the patient is affected by pulsed currents of low frequency of 1-2 Hz, supplied to the patient’s body from the apparatus “Lymphavigins” using two electrodes located at the largest the perimeter around the lesion area relative to the pathways of the lymphatic current, with a current strength of 3 to 15 mA, individually for each patient, until sensation of characteristic lungs of visible muscle contractions, The exposure time is 8-10 minutes, for a course of 6-10 daily procedures.