RU2467775C1 - Method of treating chronic hematogenous osteomyelitis in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to physiotherapy. Method includes contact impact on lesion focus. Impact is performed with extremely high-frequency electromagnetic field. Preliminary impact is performed on the area of lymph nodes in inguinal region. Impact is performed with wavelength 5.6 mm, frequency 53.5 GHz, intensity 10 mW/cm². Impact lasts 20 minutes. After that, impact is performed on lesion focus. Impact is performed with wavelength 7.1 mm, frequency 42.2 GHz, intensity 10 mW/cm². Impact lasts 20 minutes. Procedures are performed daily. Course of treatment includes 10 procedures.

EFFECT: method can be used in treatment of children of any age, in presence of metal constructions, wet bandages.

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Description

The invention relates to physiotherapy and pediatric surgery and is intended for the treatment of children with chronic osteomyelitis, including in the postoperative period.

Chronic osteomyelitis occurs as a result of acute hematogenous osteomyelitis. A characteristic sign of chronic osteomyelitis are scars or fistulas, which, when remitted, close or appear as a small serous-purulent discharge. Often the occurrence and presence of a constant purulent focus leads to the development of dystrophic changes in the muscular system of the limbs and internal organs. Radiologically chronic hematogenous osteomyelitis is characterized by an increase in the proliferative ossification process and the formed pathological structure of the bone. Bone porosity decreases and is replaced by osteosclerosis with sequestration.

Surgical treatment of this pathology in the presence of fistulas is the main treatment method, and physiotherapeutic methods are also widely used to prevent complications in the form of deformation and impaired limb growth, pathological fractures, false joints and various bone defects, etc.

Physiotherapy for chronic osteomyelitis is aimed at preventing exacerbation of the process, stimulating blood circulation and lymph flow in the bone and surrounding tissues, stimulating general and local immunity.

Known methods for physiotherapeutic treatment of chronic hematogenous osteomyelitis using microwave decimeter therapy (frequency 460 MHz, wavelength 65 cm) and microwave therapy (frequency 2450 MHz, wavelength 12.2 cm). These methods are assigned to the projection of the lesion in the bone, in a low thermal dosage. The duration of the procedure is 15 minutes, the course of treatment is up to 15 procedures. (Mitbraith I.M. et al. Physical factors in the treatment and rehabilitation of traumatological and surgical patients. / Balneology and physiotherapy / Edited by V.M. Bogolyubov. - M., Medicine. - 1985. - v.2. - p. .431.)

However, the scope of this method is limited.

So, for example, this method cannot be used if the patient has applied ointment and wet dressings, in the presence of metal structures. In addition, when using the method, exacerbation is not excluded, especially with fistulous form, due to the deep penetration of the factor and thermal effects.

A known method of treating chronic hematogenous osteomyelitis in children, including contact exposure to the lesion by a high-frequency electromagnetic field. (Mitbraith I.M. et al. Physical factors in the treatment and rehabilitation of traumatological, orthopedic and surgical patients. / Balneology and physiotherapy / Edited by V.M. Bogolyubov. - M., Medicine. - 1985. - v.2. - p. 431).

In this method, a frequency of 13.5 kHz is used in a low thermal dosage, when the inductor is located on the projection of the site of inflammation. The duration of the procedure is up to 15 minutes, the course of treatment is 10 procedures.

The disadvantage of this method is the risk of exacerbation of the inflammatory process with purulent discharge from the fistula, the inability to use in hypotonic conditions, the presence of metal structures and wet dressings. There are contraindications for the treatment of children under the age of 5 years.

In order to eliminate the described drawbacks, the authors set a task aimed at creating a method with wide functional capabilities by providing anti-inflammatory local action, improving blood circulation in the focus of inflammation, stimulating immunity, and restoration processes in bone tissue. In addition, the method has no contraindications for the age and condition of the wound, the presence of metal structures.

To solve this problem, in a method of treating chronic hematogenous osteomyelitis in children, which includes contacting the lesion with a high-frequency electromagnetic field, it is proposed to carry out an exposure with an extremely high-frequency electromagnetic field, and preliminarily act on the region of lymph nodes located in the inguinal region with a wavelength of 5.6 mm , with a frequency of 53.5 GHz, with an intensity of 10 mW / cm ² , for 20 minutes, and then at the lesion site with a wavelength of 7.1 mm, with a frequency of 42.2, GHz, with an intensity of 10 mW / cm ² , in reading 20 minutes. The course of treatment is 10 daily procedures.

The influence of extremely high-frequency therapy of millimeter-wave electromagnetic radiation - EHF (5.6 mm, 53.5 GHz; 7.1 mm, 42.2 GHz) due to the short wavelength is well absorbed by water molecules, hydrated proteins and collagen fibers and has a low penetrating into the skin of 0.2-0.6 mm, the energy flux density does not exceed 10 mW / cm ² . According to the literature, the therapeutic effect of EHF-therapy is associated with the management of recovery processes and the mobilization of the body's own reserve capabilities. EHF exposure stimulates non-specific adaptive resistance in the body, while protective (immune status) and regulatory (neurohumoral factor) functions are mobilized, physicochemical properties and lipid composition of biological membranes are changed. As a result, treatment with EHF-therapy improves blood circulation in the focus of inflammation. The method has an anti-inflammatory, analgesic effect, stimulates regeneration processes, immunity, and helps prevent exacerbation of the process. The procedure does not cause discomfort to the patient, does not have a thermal effect and can be used both in remission and in the acute stage, combined with medical and surgical methods of treatment at any stage of the inflammatory process. Exposure to the lymph nodes in the inguinal region stimulates the immune system. Lymph nodes after the skin and mucous membranes are the second barrier to infection that attacks the body. The tissues of the body are drained by the lymphatic vessels, through which the lymph enters the marginal sinus through the lymphocytes of the cortex to the macrophages and sinuses of the medulla, then through the efferent vessels, the lymph enters the thoracic duct, and from there into the blood. In the formation of the immune response, T-lymphocytes located in the lymph node turn into lymphoblasts and actively proliferate, stimulating immune processes.

The implementation of the treatment method is illustrated by specific examples.

Example 1

Patient K., born in 1996, was in the Department of Pediatric Surgery MONIKI since 09.06.2011 with a diagnosis of chronic osteomyelitis of the right humerus.

He was hospitalized in the direction of the regional medical institution; upon admission, he complains of pain in the shoulder, limited movement in the shoulder joint, slight swelling of the shoulder, and low-grade fever. In the clinical analysis of peripheral blood: leukocytes 18.2 × 10 ⁹ , ESR - 20 mm / hour, an increase in platelets, stab leukocytes, a decrease in the number of lymphocytes, a decrease in total protein, an increase in CRP to 5 mg / L. Protein fractions: total protein - 72 g / l, albumin - 55%. Globulins - alpha 1 - 3%, alpha 2 - 8%. Beta - 11%, gamma - 23%, A / G index = 0.8. At admission, an increased content of calcium and phosphorus was noted, which is explained by phosphorus-calcium demineralization of the bone during the course of the disease.

An X-ray of the right humerus did not show bone-destructive changes, a periosteal reaction was noted.

A comprehensive treatment was carried out, including drug therapy and physiotherapy according to the proposed method: EHF therapy was initially performed on the lymph nodes of the inguinal region, while the radiation wavelength was 5.6 mm, frequency 53.5 GHz, intensity 10 mW / cm ² , for 20 minutes, then EHF on the projection area of inflammation in the bone, a wavelength of 7.1 mm, a frequency of 42.2, GTZ, an intensity of 10 mW / cm ² for 20 minutes. The course of treatment is 10 daily procedures.

As a result of treatment, pronounced positive dynamics were noted: the pain syndrome was significantly reduced, swelling was gone, and the range of movements in the joint increased. In the clinical analysis of peripheral blood, leukocytes are 11.2 × 10 ⁹ , ESR - 6 mm / h, total protein 76 g / l, albumin 42.55%. The dynamics of a decrease in serum IgM and IgA, an increase in HCT phagocytosis and a latex test were noted. An increase of 3% in the CEC before treatment tends to decrease.

Example 2. Patient G., born in 1999, with a diagnosis of post-traumatic osteomyelitis III of the metatarsal bone of the right foot.

Directed to treatment by a regional clinic. Upon receipt of the fistula with purulent discharge in the area of the arch of the foot, minor pain, swelling, low-grade fever, restriction of movement in the foot.

In a clinical blood test L = 6.6 × 10 ⁹ ESR - 15 mm / h, urinalysis without pathology, a slight increase in alkaline phosphatase and CP protein was noted in a biochemical blood test.

On the roentgenogram, the presence of the fistulous course and periosteal reaction.

Complex treatment was carried out, including drug therapy and physiotherapy according to the proposed method: EHF therapy was initially performed on the lymph nodes of the inguinal region, while the radiation wavelength was 5.6 mm, the frequency was 53.5 GHz, the intensity was 10 mW / cm ² , and for 20 minutes, then EHF on the projection area of inflammation in the bone, a wavelength of 7.1 mm, a frequency of 42.2, GHz, an intensity of 10 mW / cm ² for 20 minutes. The course of treatment is 10 daily procedures.

After the treatment, a decrease in discharge from the fistula was noted, it acquired the character of a sacrum, the absence of pain, swelling, and an increase in the range of motion in the foot area. In the clinical analysis of peripheral blood L = 5.6 × 10 ⁹ , ESR - 9 mm / h, normalization of alkaline phosphatase and CRP in a biochemical blood test, pronounced positive dynamics of immunity indicators (IgA, IgM, IgG, CEC, HCT and latex test). On the roentgenogram, the presence of the fistulous course, a slight periosteal reaction.

Method effectiveness

Using this method, 8 people were treated with a positive effect. The advantage of this method is the simplicity of the procedure, the use of domestic portable equipment that allows treatment in the ward, taking into account the severity of the pathology, and the practical absence of contraindications.

Claims (1)

A method for the treatment of chronic hematogenous osteomyelitis in children, comprising contacting the lesion with an electromagnetic field, characterized in that the exposure is carried out by an extremely high-frequency electromagnetic field, and previously affect the area of the lymph nodes located in the inguinal region, a wavelength of 5.6 mm, frequency 53 5 GHz, intensity 10 mW / cm ² , for 20 min, and then to the lesion site, wavelength 7.1 mm, frequency 42.2, GHz, intensity 10 mW / cm ² , for 20 min, course treatment is 10 daily treatments.