In orthopedic and trauma practice occurs a number of pathologies, therapeutic treatment which is ineffective, and surgery for various reasons is undesirable. Such diseases include chronic polyarthritis, deforming arthrosis 2–3 stage, meniscus injury, and so on.
The technical result is achieved using a method of treating inflammatory and degenerative pathologies by intra-articular joint modeling is the high efficiency of therapy, allowing to achieve a complete cure, able to avoid surgery, including joint replacement, the possibility of outpatient treatment, the absence of contraindications.
The inventive effect is achieved in the implementation of a method for treating inflammatory-degenerative pathologies of joints, comprising the fact that the treatment is carried out in three stages, the first of which is conducted in at least one course of combined therapy aimed at suppressing the inflammatory response and pain relief. The second stage is used, at least one session focused extracorporeal shock wave therapy Ultra High Power, aimed at creating a thicker cartilage microcavities that the third stage is filled with modeling compound, which is used as a mixture of 15 parts of particulate biopolymer gel, 65 parts of hyaluronic acid, 15 parts of the extract of animals cartilage and 5 parts of Dimexidum solution, and filling is carried out by intraarticular microcavities electrophoresis followed by stabilization via noninvasive pulsed infrared laser with a high-with a wavelength of 785 nm, while ensuring the heating of the filling simulator to 44 degrees Celsius.
The main difference of the method for treatment of inflammatory and degenerative pathologies by intra-articular joint modeling from other known methods is to create a micro-cavities in the intra-articular cartilage, and then fill the cells by the modeling structure and stabilization of the resultant structure, to achieve full recovery of shape, volume and consistency of the normal intra-articular cartilage
Combined therapy at the first stage of treatment includes microwave heating of the musculo-ligamentous apparatus of the affected joint, ultrasound therapy and drug anti-inflammatory therapy.
Microwave heating of the musculo-ligamentous apparatus of the affected joint is electromagnetic radiation between radio waves and infrared at a frequency of 30 GHz 300MGts. In medicine uses three frequencies and microwaves respectively three lengths: 2450 MHz (12.245 cm), 915 MHz (32.79 cm) and 433.9 MHz (69.14 cm). In Europe, the use of all three frequency microwave therapy in the US – only the first two.
For the electromagnetic field of the microwave magnetron vacuum is used, combining the functions of electronic valves and oscillating circuit. The electron source is a magnetron cathode. The electric field between the cathode and anode accelerates the electrons. Small-sized permanent magnet, which is equipped with a magnetron, produces a magnetic field directs the movement of electrons. The electromagnetic field of the microwave supplied to the tissue via special directional emitters which constitute the dielectric antenna. Radiators are used for contact and remote methods of exposure. When the remote unit is set in the exposure screened cabin, so that the emitter is directed towards the outer wall.
Microwave energy is mainly absorbed by water molecules, the permeability of the dielectric in connection with this small. When exposed to microwaves in the centimeter range dipoles of water have time to turn around completely for one sign change polarity. Absorption of energy occurs primarily in tissues rich in water. Largely reflect their skin surface, take into account that at a dose procedure is not possible. Depending on the thickness of the subcutaneous fat layer and the emitter is reflected location features 25 to 75% of microwave energy, on average about 40%. Much a reflection of their interfaces from other tissues: skin – subcutaneous fat, subcutaneous tissue – muscles. Thus, the formation of so-called «standing» wave in the tissue. They are formed when a wave is reflected from the boundary between two media, and the imposition of the reflected to the next incident wave. According to the laws of physics «standing» wave is formed in the case, if the distance between the boundaries of the two media is more than a quarter wavelength. This situation can occur when the thickness of the subcutaneous fat layer more than 2 cm.
Microwaves (UHF-therapy) is about twice less intense reflective surface of the skin. They are less than a centimeter wavelength range absorbed by water, since the phenomenon of resonance of dipoles of water at this frequency electromagnetic fields are less pronounced. The energy of these waves as the penetration depth of the tissue dies twice as slow compared to centimeter waves. Warming tissue UHF therapy occurs at a depth of 3 cm. In the formation of «standing» waves are significant local increase in tissue temperature up to burn. This overheating of tissue accompanied by a feeling of fullness, burning, bursting pain that requires immediate dose reduction or cessation of exposure procedures.
Physiological effects of exposure to microwave treatment on a living organism are to improve the metabolic activity of cells, reducing the viscosity of all liquids, increasing the extensibility of collagen, increase blood flow, effective impact on the nervous system.
The therapeutic effect of microwave radiation is shown as an anesthetic (due to the direct effects on pain gate, accelerated removal of irritants and by increasing blood flow, reducing muscle spasms, sedation), reduction or complete cessation of muscle spasm due to direct effects on muscle spindle-shaped structure, the acceleration recovery by increasing the metabolic activity that has an impact on post-traumatic process and course of chronic infection, softening of collagen tissue, scar tissue and other fibrosis, treatment of muscle tissue by increasing intramuscular blood flow.
On the oscillatory effect associated anti-inflammatory effect of microwaves, anti-allergic effect, a positive effect on immunegenesis. Despite the fact that the action of the microwaves spread in a small volume of tissue, the overall reaction can be observed. They are implemented mainly through strengthening the function of the parasympathetic division of the autonomic nervous system: lowering blood pressure, slowing of the heart rate, slowing intraventricular conduction in the heart. Stimulation of synthesis of some prostaglandins.
With the thermal effect of microwaves connected analgesic effect, the intensification of blood and lymph circulation in the tissues, the intensification of metabolism. It should be remembered that the oscillator and thermal effects are inseparable and are shown simultaneously.
Ultrasound is a form of mechanical energy and represents the mechanical vibrations of an elastic medium frequency greater than 16 kHz, which are not perceived by the human ear. These vibrations are transmitted as a longitudinal wave causing alternating compression and rarefaction of the medium or material.
The greater the power of the transmitted energy, the greater the amplitude of the deviations of the particles of the medium on the initial state. The distance includes a compression region and a vacuum region is a wavelength which is inversely proportional to the oscillation frequency.
Low frequencies ultrasonic waves are propagate spherically With increasing oscillation frequency and accordingly, reduce the wavelength of ultrasonic beam becomes straightforward. Rectilinear propagation of ultrasonic waves of high frequency (800–3000 kHz) is responsible for their use in physiotherapy. These waves propagate parallel to each other, they can be concentrated in a limited area. Absorption of ultrasonic waves varies in different tissues. For example, the absorption coefficient for the ultrasonic bone 12–15 times higher compared to the muscle tissue. In general, the higher the oscillation frequency, the more intense the absorption, the less the penetration depth. High frequency ultrasound intensely absorbed by the air.
His slightest layer between the emitter and the surface of the skin retain ultrasonic waves. In this regard, the therapeutic effect using airless contact medium: petrolatum, glycerin, lanolin. In those cases where not possible contact between the ultrasound transducer and the skin surface (area of hand, foot), exposure is performed remotely through the water with a gap of 1–2 cm. For ultrasound using a reverse piezoelectric effect.
Under the piezoelectric effect to understand the phenomenon of electric polarization of crystals caused by their mechanical deformation: compression, tension, bending, torsion. These properties are quartz crystals of barium titanate and others. On the other hand, by placing the crystals in a variable electric field, they are stretched and compressed, depending on the field direction. The frequency of the received mechanical oscillations corresponds to the frequency of the electric field. Thus, the apparatus for obtaining ultrasonic generator comprises an ultrasonic high frequency transducer (vibrator applicator) in which is placed the plate barium titanate or quartz.
Ultrasonic emitter tightly pressed against the surface of the skin in the affected joint or, if not possible close contact, the remote wire exposure through water. Remote method is used in cases when the treated surface of the body has a complicated shape (fingers and toes) or larger surface area. For this purpose, a glass or ceramic cuvette filled with water or a drug solution, the entire portion of the body is placed, which is intended to be subjected to ultrasonic radiation. Then immersed in the water a source of ultrasound (emitting head) and include ultrasonic wave generator.
Basic biophysical processes in tissues associated with the three main effects of ultrasound: mechanical (mechanics and dynamic), physico-chemical and thermal.
Mechanical action is manifested at the cellular and subcellular levels. The impact of high-intensity ultrasound leads to rupture of tissue with the formation of microscopic cavities, the existence of which is comparable with the period of ultrasonic vibration. The mechanical action of the low intensity ultrasound that is used in physiotherapy is vibrational micromassage tissues. In this case, cells and tissue structures amplified diffusion and osmosis processes.
Physico-chemical activity of ultrasound is associated with complex electron quantum phenomena at the molecular level. Accelerating the movement of molecules, increasing the formation of ions. In tissues increases the number of free radicals, activate the formation of biologically active substances and redox reactions, increased dispersion colloids cells. In therapeutic ultrasound dosages is the catalyst of biochemical reactions.
Thermal effect associated with the conversion of mechanical energy into heat, ie it comes to endogenous heat. Heat is produced primarily in the tissues rapidly absorbing ultrasound: nervous tissue, bones. Is heated throughout the tissue is the volume heating, heat is generated as the boundary between two media of different acoustic density – structural heating. As used in physiotherapy small intensity ultrasound noticeable increase tissue temperature during treatment is not observed. Thermal effect in this case, plays a secondary role.
Depending on the applied dose can be observed damaging, depressing and stimulating effect of ultrasound. In physiotherapy using doses which cause a stimulating effect without causing destructive changes in the tissues. To determine the optimal frequency, power and duration of radiation treatments are standard tables for physical therapy ultrasound, wherein the dose of radiation depends on the depth of the surface area and the pathological focus.
Depending on the depth of the chamber and its surface should apply a different power and irradiation time. The depth of tissue penetration of ultrasound frequency of 800–1000 kHz is estimated at 5–6cm, frequency of 2400 kHz – three times less. Best ultrasound penetrates into the fatty tissue of the nervous and muscular delayed. A significant number of ultrasound is absorbed at the interface tissue with varying acoustic density. From bones reflect 60% of the incident ultrasound energy. In small subthreshold doses ultrasound can penetrate to a depth of 20 cm as the data visualization of reflected waves from this depth. This fact is used in the ultrasonic diagnosis.
Physiological responses associated with the main biophysical effects are closely intertwined and interact. At therapeutic doses, ultrasound has a generally stimulating effect on cell function. In the initial phase effects observed swelling of mitochondria, variations in the structure of the matrix structure of cell shape becomes blurred.
Irritation of cells leads to activation of its activity, strengthening the respiratory activity of mitochondria. In general, there is a biological effect of stimulation, which lasts for several hours after a single exposure. Higher doses cause abrupt changes in cellular microstructures inhibit the activity of cells, there are signs of the damaging effect
Under the influence of ultrasound on the connective tissue is observed rejuvenation of its cellular and fibrous structures. There are cells with abundant cytoplasm represented mainly substance increases the amount of elastic fibers and collagen formation is inhibited. When exposed to excessive connective tissue with ultrasound has restructured, that makes more elastic scar.
Low intensity ultrasound accelerates regeneration of damaged nerve fibers, reduces the sensitivity of receptors, which is manifested analgesic effect. The ultrasound acts on the receptor apparatus of the skin without causing any noticeable subjective sensations. Most sensitive to its effects, facial skin and stomach.
Impact on skin receptors specific reflex zones leads to the common responses that are realized through higher autonomic centers of the hypothalamic-pituitary system. According to this mechanism of action of ultrasound therapy increases the lability of the nerve centers and the adaptive-trophic functions of the whole organism. In some medical procedures used is the total effect of ultrasound.
Anti-inflammatory therapy is to appoint a course of non-steroidal anti-inflammatory drugs (Voltaren 75 mg × 3 ml) by intramuscular injection 1 ampoule 3 times a week, but not more than 10 ampoules for the entire course of treatment
The success of the first phase of treatment is determined by the results of repeated ultrasound images of the affected joint, which is determined by the dynamics of change in the severity of soft tissue swelling. In some cases, during the shots may be necessary magnetic resonance imaging (MRI).