RU2436584C1 - Method of treating degenerative-dystrophic musculoskeletal diseases and posttraumatic adhesive processes - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention refers to medicine, namely to traumatology and orthopaedics, and can be used for treating degenerative-dystrophic musculoskeletal diseases and posttraumatic adhesive processes. That is ensured by preparing a suspension of the following composition: the ointments Indometacin, Chondroxide, Essaven gel in proportions 1:1:1 mixed with the preparation Karipazim 50 mg dissolved in physiologic saline 5 ml, 2 % Trental and vitamin E solution 100 IU. The prepared suspension is introduced to the patient by phonophoresis within 5 minutes per a field. The therapeutic course is 15-20 procedures. ^ EFFECT: invention allows reducing total length of rehabilitation of the patients and increasing a remission period endured by an integrated effect on a pathological process during each therapeutic procedure. ^ 3 ex, 4 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the complex treatment of post-traumatic dystrophic, degenerative and scar adhesions in the field of joints, deforming osteoarthritis of large joints and osteochondrosis.

Widely known methods of local therapy of lesions of the musculoskeletal system with ointment forms of non-steroidal anti-inflammatory drugs such as diclofenac, ibuprofen, ketoprofen, indomethacin [Alekseeva L.I. // Russian Medical Journal. - 2000. - T.8 - No. 9. - S. - 377-386, Chichasava N.V. // Russian Medical Journal. - 2001. - T.9 - No. 7-8. - S. - 286-288]. The main indications for their use are synovitis, inflammatory diseases of periarticular tissues, post-traumatic pain syndromes, back pain. Ointments are applied to the skin in the affected area many times during the day in order to provide an adequate analgesic and anti-inflammatory effect. Clinical studies have shown [Chichasava N.V. // Russian Medical Journal. - 2001. - T.9 - No. 7-8. - S. - 286-288], that the minimum is 3-4-fold application of the drug per day, and with active inflammation, the frequency of application can increase up to 5-6 times a day.

The disadvantage of this method is the need for repeated application of the drug to the skin during the day to maintain the optimal concentration of the active drug in the tissues. Elderly people need to increase the amount of the drug applied or increase the frequency of its use due to reduced (due to physiological characteristics) skin permeability [Chichasava N.V.// Russian Medical Journal. - 2001. - T.9 - No. 7-8. - S. - 286-288]. The introduction of these drugs by phonophoresis provides a more reliable penetration of the drug to the site of inflammation [Chichasava N.V. // Russian Medical Journal. - 2001. - T.9 - No. 7-8. - S. - 286-288, Elder B.C. new methods and techniques of physical therapy // Ulaschik B.C. - Minsk, Belarus, 1986. - S.175].

A known method of treating arthrosis of large joints by phonophoretic introduction to the lesion area of hydrocortisone. [Reshetov P.P., Tverdokhleb Yu.P., Bezmenov V.A. // Issues of balneology, physiotherapy and physiotherapy - 2000. - No. 4. - S. - 47-48]. Indications for such treatment are arthrosis of large joints of I-II art. with synovitis. In general, during treatment with the proposed method, improvement, manifested by a decrease in pain, is noted by 70% of patients [Reshetov P.P., Tverdokhleb Yu.P., Bezmenov V.A. // Issues of balneology, physiotherapy and physiotherapy - 2000. - No. 4. - S. - 47-48].

The disadvantages of this method are the possibility of purulent-inflammatory complications in the skin at the site of application of the drug (due to the reduction of local skin protection factors by glucocorticosteroids), the low efficiency of the method under monotherapy.

In the literature there is evidence of the possibility of using Capsicam ointment in the complex treatment of degenerative ulcerative diseases of the musculoskeletal system. The ointment contains dimethyl sulfuccide, a combination of two active vasodilating components for topical application - vanillylnonamide and benzyl nicotinate, as well as turpentine and camphor, which have an irritating and analgesic effect. In this case, the ointment must be applied at least 2-3 times a day [Kuryata I.V., Belozerova E.V., Kharkiv S.V.// Medical practice - 2004. - No. 3-4. - S. - 97-100] to ensure a sufficient clinical effect, manifested in a decrease in pain and a decrease in inflammatory phenomena.

The disadvantages of this method are the need for repeated application of the drug during the day to ensure an adequate effect declared by the manufacturer, as well as a low clinical effect with monotherapy.

There is a method of treating neurological and traumatologic orthopedic diseases associated with the development of scar adhesions by electrophoretic administration of the proteolytic enzyme preparation Karipazim obtained from the latex of Carica papaya melon tree [Pat. 2141359. RF, MKI A61N 1/30, A61K 35/78 A method for the treatment of neurological and orthopedic and traumatological pathologies]. This method is used, for example, in the treatment of cervical and lumbar osteochondrosis, discogenic radiculitis, facial neuritis, keloid and hypertrophic scars. At the same time, filter paper is moistened with a solution of the Karipazim drug with the addition of dimethyl sulfoxide (DMSO), applied to the skin in the area of pathology, an electrically conductive pad and a positive electrode are placed on top, and additional administration of aminophylline or potassium iodide is possible from the negative electrode. The disadvantages of this method of treatment are:

- insufficient severity of analgesic and decongestant effects,

- the need for a long course of therapy.

According to modern standards of treatment of osteoarthritis [Alekseev L.I. // Russian medical journal. - 2000. - T8 - No. 9. - S. - 377-386, Borovikov N.N. Modern approaches to the complex treatment of osteoarthritis using Chondroxide ointment // Borovikov N.N. - Nizhny Novgorod. NIZHFARM. 2002. - S. - 28, Chichasava N.V. // Russian medical journal. 2003. - T.11 - No. 23. - S. - 1277-1279], the complex therapy of this disease should include drugs with chondroprotective properties, which are the natural components of cartilage - hyaluronic acid, glucosamine and chondroitin sulfate. Chondroprotectors improve cartilage metabolism, slow down or prevent its destruction. There is a method for the treatment and prevention of the progression of degenerative joint diseases through the use of ointment "Chondroxide" 5%, which is one of the most famous and affordable drugs and gives a pronounced therapeutic effect when applied topically. Due to the presence of dimethyl sulfoxide in the ointment, the drug - chondroitin sulfate - penetrates deep into the tissue. The ointment is applied 2-3 times a day to the skin over the lesion and rubbed until completely absorbed for 2-3 minutes. The course of treatment is 2-3 weeks. The disadvantage of this method are:

- its low efficiency in monotherapy,

- the need for repeated use of the drug during the day,

- lack of anti-inflammatory effect,

- lack of decongestant effect.

The closest prototype to our proposed method is a method for the treatment of degenerative diseases of the musculoskeletal system [Pat. No. 2274472], which includes applying to the affected area ointments Indomethacin, Chondroxide, Essaven gel in a ratio of 1: 1: 1, mixed with 50 mg of Karipazim, dissolved in 5 ml of physiological saline. The suspension is administered by ultraphonophoresis for 5 minutes on the field, daily, in a course of 15-20 procedures. The disadvantages of this method are:

- insufficiently expressed analgesic effect,

- insufficiently pronounced decongestant effect.

We have for the first time developed a method for the treatment of degenerative-dystrophic diseases of the musculoskeletal system, which allows a comprehensive effect on the pathological process during one treatment procedure. The proposed method involves applying to the affected area ointments of Indomethacin, Chondroxide, Essaven gel, Karipazim enzyme preparation, Trental 2% solution and Vitamin E solution (100 ME), and drugs are applied in the form of a suspension of the following composition: Indomethacin ointment, Chondroxide and Essaven gel 1: 1: 1 proportions mixed with 5 ml of Trental 2%, 1 ml of vitamin E and 50 mg of Karipazim, dissolved in 5 ml of physiological saline. The suspension is administered by ultraphonophoresis for 5 minutes on the field, daily, in a course of 15-20 procedures.

The method is as follows. An agitated suspension is prepared, for which purpose Indomethacin ointments 10%, Chondroxide 5%, Essavens gel are mixed in a 1: 1: 1 ratio. The amount of ointment depends on the size of the joint: for large joints (knee, shoulder) a strip of ointment 5-10 cm long is squeezed out, for medium joints (ulnar, wrist, ankle) 3-5 cm (according to the recommendations [N.V. Chichasava // Russian medical Journal. - 2001. - T.9 - No. 7-8. - S.286-288]). Then add 50 mg of the powdered preparation Karipazim with an activity of 350 PE dissolved in 5 ml of physiological saline, 5 ml of Trental 2% and 1 ml of vitamin E. The talker is applied to the skin in the area of pathology. Then they are influenced by low-frequency ultrasound with an intensity of 0.2-0.4 W / cm ² paravertebrally and 0.4-0.6 W / cm ² on the limbs and joints for up to 5 minutes on the field (according to the standard method [Ulashchik BC methods of physical therapy / V.S. Ulashchik. - Minsk: Belarus, 1986. - S. - 175]). Ultraphonophoresis is carried out daily, for a course of 15-20 procedures. If necessary, repeat the treatment.

Chondroprotector - Chondroxide ointment and Indomethacin ointment, which has a local analgesic, anti-inflammatory and anti-edema effect, Essaven gel, which improves microcirculation and also has analgesic, anti-edema and anti-inflammatory properties, are used in combination with Caripazim, Trental and Vitamin E for the treatment of various diseases -dystrophic diseases of the musculoskeletal system and potentiation of the therapeutic effect. The method of introducing these drugs selected low-frequency ultrasound, because this complex satisfies several conditions [B. Clerk. New methods and techniques of physical therapy / B.C. Ulashchik. - Minsk: Belarus, 1986. - S. - 175, Pavel B.C. Essays on General Physiotherapy / V.S. Ulashchik. - Minsk: Navuka i tehnika, 1994. - S. - 200]:

- The ointment bases that are part of the ointments Chondroxide, Indomethacin and Essaven gel are a suitable contact medium for ultrasound.

- Vitamin E is a fat-soluble vitamin, which contributes to better dissolution of the drug when mixing the components.

- For ultra-phonophoretic administration, bioactive compounds are used that exhibit their maximum effect even at low dosages, including the enzyme preparation Karipazim and the structural modulator chondroitin sulfate, which is part of the Chondroxide ointment.

- These drugs in their effect on the pathogenetic links of the disease are synergistic with the action of a physical factor, because low-frequency ultrasound provides the occurrence of the phenomenon of tissue micromassage, loosening, improving microcirculation and regional blood circulation, accelerating diffuse and metabolic processes [Ismayilov AA, Kuliev R.A. / Bulletin of surgery. - 1985. No. 2. - S.146-148], stimulates the regenerative processes [B.Schastik.C.// Questions of balneology, physiotherapy and physiotherapy. - 2000. - No. 6. C.3-8]. Under our supervision, there were 26 patients aged 21 to 59 years with diseases of the musculoskeletal system. The distribution of the diagnoses is presented in table 1. Depending on the type of treatment, we identified three groups of patients.

Number of patients Diagnosis I group II group Gonarthrosis stage I-II 5 3 Injuries of capsular ligaments of various joints four 5 Osteocondritis of the spine four 5 Number of patients 13 13

Group I patients received treatment according to our proposed method. They performed the phonophoretic administration of a drug suspension of the following composition: Chondroxide ointment 5%, Indomethacin ointment 10%, Essaven gel in a ratio of 1: 1: 1, with the addition of 50 mg of a powdered preparation Karipazim with an activity of 350 PE dissolved in 5 ml of physiological solution, 5 ml Trental 2% and 1 ml of vitamin E (100 PE). The suspension was applied to the skin in the area of pathology, then it was exposed to low-frequency ultrasound.

The second group of patients was performed by phonophoresis of a drug suspension of the following composition: Chondroxide ointment 5%, Indomethacin ointment 10%, Essaven gel in a ratio of 1: 1: 1, with the addition of 50 mg of a powdered preparation Karipazim with an activity of 350 PE dissolved in 5 ml of physiological solution. All groups of patients received procedures daily; the course of treatment was 15 procedures.

In the course of treatment, we monitored the dynamics of the patients' condition. The following indicators were investigated: joint pain at rest, during movement, local swelling of periarticular tissues, increased joint mobility. Each indicator was evaluated on a 10-point scale, with “0” points corresponding to its minimum severity, “10” points - maximum. The dynamics of the indicators in the treatment process is shown in figures 1, 2, 3, 4 on the graphs presented on the X axis, the duration of treatment (the number of procedures) is postponed, on the Y axis, the severity of the indicators in points. The figure 1 shows the dynamics of the severity of pain at rest, in figure 2 - with active movements. The figure 3 presents the change in the local swelling of periarticular tissues during treatment. The figure 4 shows the process of improving mobility in the affected joints.

In group I of patients treated by our proposed method, there was a significant decrease in the intensity of the pain syndrome at rest and with active movements after 2 procedures, after 4-5 procedures, its intensity almost halved, and by the end of the course of treatment (after 14-15 procedures ) pain was stopped in 95% of patients. In group II patients, the intensity of pain at rest and during active movements decreased after 4-5 procedures, and a more significant improvement was achieved after 7-8 procedures, after the end of treatment, the pain syndrome was completely stopped in 75% of patients. In the state of periarticular tissues, a more pronounced positive dynamics was observed in group I of patients: local swelling and edema significantly decreased after 4-5 procedures, by the end of treatment they were slightly expressed in most patients. In group II, the manifestation of this symptom began to decrease noticeably after 7-8 procedures, and by the end of treatment, local swelling persisted in a larger number of patients than in group I. Improvement of joint mobility in group I began already after 2 procedures (in group II - after 3-4 procedures), after 5-6 procedures the improvement was more significant, by the end of treatment it was restored almost completely in most patients.

Example 1. Patient S., 35 years old. He has been working as a hairdresser for the past 3 years, worried about neck pain radiating to the shoulder girdle, arms, crunch in the cervical spine, dizziness when turning the head. The last 4 months there were pains in the region of the right shoulder joint during abduction of the shoulder. Symptoms intensified with prolonged forced position, with raising arms, which complicated the professional activity of the patient. She was periodically treated with non-steroidal anti-inflammatory drugs (diclofenac, ibuprofen), received physiotherapy courses (magneto, laser therapy), massage with a temporary effect. A clinical examination of the patient revealed smoothness of the cervical lordosis, pain on palpation of the spinous processes and paravertebral zones of the cervical spine, tension of the scalene and occipital muscles, and movements in the cervical spine are limited. On palpation of the region of the shoulder joint, pain was determined along the edge of the spine of the scapula, in the region of the large tubercle of the humerus, acromioclavicular joint. The abduction of the right upper limb and its lifting upward due to pain are severely limited. On the radiograph of the cervical spine, cervical lordosis is smoothed, a decrease in the height of the intervertebral discs C _IV- C _VII . Along the edges of adjacent surfaces of the vertebral bodies - marginal bone growths, sclerosis of subchondral plates. Conclusion: osteochondrosis of the cervical spine. On radiographs of the shoulder joint, pathological changes were absent. The diagnosis was made: "Osteochondrosis of the cervical spine with radicular pain, shoulder-scapular periarthritis." The following treatment was prescribed: an agitated suspension was prepared, for which Indomethacin ointment 10%, Chondroxide 5%, Essaven gel were mixed in a ratio of 1: 1: 1. Each ointment was squeezed out of the tube with a strip 10 cm long. Then, 50 mg of the powdered preparation Karipazim with an activity of 350 PE dissolved in 5 ml of physiological saline, 5 ml of Trental 2% and 1 ml of vitamin E were added. Chatterbox was applied to the skin in the area of pathology. Then they were exposed to low-frequency ultrasound with an intensity of 0.2-0.4 W / cm ² paravertebrally and 0.4-0.6 W / cm ² on the limbs and joints for up to 5 minutes on the field. Ultraphonophoresis was performed daily for a course of 15-20 procedures. After 3 procedures, the patient began to notice a decrease in pain in the neck, in the right shoulder joint. By the end of treatment, the pain significantly decreased, the function in the right shoulder joint improved. After the end of the first course of treatment, the pain syndrome was almost completely stopped, dizziness was absent, the abductions in the right shoulder joint exceeded 90. After a month and a half, the second course of treatment of 15 procedures was carried out, after which dizziness, pain in the neck, arms, and movement in the right disappeared completely shoulder joint in full. She works in her specialty, her ability to work has increased.

Example 2. Patient M., 56 years old. From the anamnesis it is known that about 5 years ago I began to feel an unpleasant dull pain, a crunch in the knee joints that occurs in the evening and with intense movements. I did not seek medical help. It was treated independently, at home. Over the past 6 months, the pain began to gradually increase, worried already with small movements in the joints, edema began to appear in the knee joints, constantly worried about a crunch during movements, as a result of which the patient turned to the district clinic, where she was recommended hospitalization in a specialized hospital. As a result, the patient was admitted to the clinic of traumatology and orthopedics with a direct diagnosis: "Deforming osteoarthrosis." Clinical and radiological examination revealed a symptom complex of osteoarthrosis of both knee joints. Consulted by a rheumatologist - rheumatological tests are negative, the autoimmune nature of the disease is excluded, with a clinical examination, swelling in the area of both knee joints and pain during active and passive movements in them were determined. On radiographs of both knee joints revealed a narrowing of the joint gap, the presence of osteophytes, signs of subchondral osteosclerosis. Conclusion: signs of osteoarthrosis of the II degree of both knee joints. The diagnosis was made: “Osteoarthrosis, localized form. Bilateral gonarthrosis. " The following treatment was prescribed: an agitated suspension was prepared, for which Indomethacin ointment 10%, Chondroxide 5%, Essaven gel were mixed in a ratio of 1: 1: 1. Each ointment was squeezed out of the tube with a strip 10 cm long. Then, 50 mg of the powdered preparation Karipazim with an activity of 350 PE dissolved in 5 ml of physiological saline, 5 ml of Trental 2% and 1 ml of vitamin E were added. Chatterbox was applied to the skin in the area of pathology. Then they were exposed to low-frequency ultrasound with an intensity of 0.2-0.4 W / cm ² paravertebrally and 0.4-0.6 W / cm ² on the limbs and joints for up to 5 minutes on the field. Ultraphonophoresis was performed daily for a course of 15-20 procedures. After 2 procedures, the patient began to notice a decrease in pain in the knee joints. By the end of treatment, the pain was significantly reduced, and function in both knee joints improved. After the course of treatment, the pain was stopped, active and passive movements were carried out in almost full physical volume.

Example 3. Patient G., 51 years old. From the anamnesis it is known that about 8 months ago, pains of a drilling nature in the lumbosacral region, independent of the time of day, began to disturb. Over the next 2 months, their intensity gradually increased, the patient could not make turns of the body in full physical volume due to pain. I did not receive treatment. In the last weeks before entering the hospital, he began to notice the appearance of paresthesia at the level of the left lower leg and foot, consisting in a feeling of numbness and crawling ants. They became difficult due to pains of movement of the spine around the horizontal axis. He sought medical help at the clinic at the place of residence, from where he was sent to a specialized hospital. He entered the clinic of traumatology and orthopedics. Clinical and radiological examination revealed a symptom complex of osteochondrosis of the lumbosacral spine. Objectively revealed the limitation of the volume of active and passive body movements around the sagittal and horizontal axis. The patient underwent MRI of the spine at the level of L _III- S _II . Conclusion: protrusion of the intervertebral discs L _III -L _IV without compression of the dural sac, signs of degenerative-dystrophic changes in the joints of the spine at the level of the lumbosacral region. According to the results of a clinical examination and MRI data, the diagnosis was Osteochondrosis of the lumbosacral spine, pain. Sciatica. The stage of exacerbation. ”The patient was given the following treatment: a shaken suspension was prepared, for which they were mixed in a ratio of 1: 1: 1 ointment Indomethacin 10%, Chondroxide 5%, Essaven gel. Each ointment was squeezed out of the tube with a strip 10 cm long. Then, 50 mg of the powdered preparation Karipazim with an activity of 350 PE dissolved in 5 ml of physiological saline, 5 ml of Trental 2% and 1 ml of vitamin E were added. Chatterbox was applied to the skin in the area of pathology. Then they were exposed to low-frequency ultrasound with an intensity of 0.2-0.4 W / cm ² paravertebrally and 0.4-0.6 W / cm ² on the limbs and joints for up to 5 minutes on the field. Ultraphonophoresis was performed daily for a course of 15-20 procedures. After the 3rd procedure, a decrease in the pain syndrome was noted, by the middle of the treatment course the pains decreased markedly, an increase in the amplitude of the body movement around the horizontal and sagittal axes was noted. By the end of the course of treatment, the pain syndrome was completely stopped, the movements were restored in full physiological volume.

Thus, the advantages of the proposed method are:

- a more effective effect on pathological tissue, since Trental (Pentoxifylline) has a direct effect on the arterial link of microcirculation, inhibits thrombosis and enhances fibrinolysis, exerts a vasodilating effect, improves tissue oxygen supply.

- Vitamin E improves tissue respiration, prevents the increase in capillary permeability and fragility, has an antioxidant effect on damaged tissue, and reduces the formation of free radicals.

- more rapid achievement of the therapeutic effect in the treatment of degenerative diseases of the musculoskeletal system and post-traumatic adhesive processes

- a reduction in the general terms of patient rehabilitation, an increase in the period of remission (from 6.5 months to 8 months), which indicates the economic efficiency of the method.

Claims (1)

A method for the treatment of degenerative-dystrophic diseases of the musculoskeletal system and post-traumatic adhesions, including the introduction of phonophoresis for 5 minutes on the field, daily, with a course of 15-20 procedures, ointment "Indomethacin", "Chondroxide", gel "Essaven" in a ratio of 1: 1: 1, mixed with 50 mg of Karipazim, dissolved in 5 ml of physiological saline, characterized in that an additional 2% Trental solution and 100 IU of vitamin E solution are added to the suspension.

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