A method for the treatment of dysplastic scoliosis in children
(57) Abstract:The invention relates to medicine, orthopedics. Realize the impact of pulsed current frequency of 60-100 Hz, power 5-15 mA 6-8 p.m Impact exercise paravertebral two or four electrodes. Conduct a traditional complex of conservative treatment. The method improves the clinical course of the disease, slows the progression of scoliosis. The invention relates to medicine, in particular physiotherapy and trapezii, and can be used in practical health care: hospital, clinic, sanatorium, specialized boarding school.Relevance and social importance of conservative treatment of dysplastic scoliosis in children (DS) is determined by a wide spread of the disease in children of preschool and school-aged 6-9%, rapid progression of the disease in 15-20% of children, which leads to the necessity of surgical intervention, not eliminate further possible disability of the child. The presence of scoliotic deformities in adulthood determines the occurrence of pain in the spine and is often the cause of accelerated development of osteochondrosis is desposable, and complete unfitness or limit young men of military age to perform military service.Known methods of conservative therapy DS in children, such as electrophoresis calcium, phosphorus and other mineral salts, ultrasound therapy and phonophoresis medicine the spine, electrical stimulation of muscles (Kots I. M. "Theory and practice.Phys. culture" NN 3, 4, 1971), as well as therapeutic exercise, therapeutic swimming, hand massage, wearing a corset. The disadvantage of these methods is their low therapeutic efficiency (63% according to C. I. Andrianov, 1983; 56% according to CITO, 1964; 69% according to the annual report spec. boarding school No. 49, S.-Petersburg) to halt the progression of DS, the need for simultaneous use of several therapeutic methods are often expensive and scarce, the compulsory wearing of a corset, which leads to limitation in motor mode, hypotrophy of muscles of the body and mechanical pressure it on the fabric. Great value and have psychological problems when communicating patients with their peers.The closest method to the present invention is a method of electrical stimulation, proposed for the treatment of DS children. AccelKey a constant pulse current frequency of 25 Hz supramaximal values (40-60 mA), supplied intermittently for 6 c, followed by a pause of 6 c. Optimum power current selected individually by performing radiography of the spine at the height of muscular contraction. Effective is current, leading to correction of the arc deformation at the time of contraction of the muscles of not less than 10owhen measured according to Cobb. Electrodes are placed on the lateral surface of the body on the mid-axillary line, depending on the results of radiological studies: (a) deformation in the region of the thoracic spine above and below the protruding ribs; b) the localization of the lumbar spine above and below the speaker vertebra; C) when combined scoliosis with 2 sides, respectively. Electrical stimulation is carried out for 6-8 hours during the night of sleep daily. Treatment continues until the bone maturity cloth spine, determined by x-ray method (J. Axelgaard. Int. Rehabil. Med., 1984, N 6, P. 31-46; Spine, 1983, N 8, P. 463-481).The disadvantages of this method are:
1. Poor portability procedures resulting in significant lateral trunk bending during shipment current for 6-8 hours during the night.s ' perform x-rays, that creates an additional radial load on the child's body and is expensive.3. In the basis of the method of treatment is the principle of training contractility of the muscles of the lateral surface of the body to maintain scoliotic deformities in the position of the correction, i.e., a biochemical approach to the problem. However, in recent years the progression of the disease is associated with dysplastic hypoplasia of the bone tissue of the spine in the inferiority of spinal structures of the Central nervous system.4. To perform the method requires 2-channel portable individual muscle stimulator, source large amounts of current (60 mA for each channel), not produced by domestic industry.The technical result of the proposed method is the prevention of disease progression and the need for surgical intervention. If there are indications for surgery electroneurostimulation (ENMS) creates favorable conditions for its implementation by increasing the support ability of the bone tissue of the vertebrae, thereby preventing the eruption of the vertebral body implanted by a distractor in the postoperative period.The choice of these parameters current attributable to the following:
1. Frequency range pulse current 60-100 Hz is the most adequate for stimulation of afferent fibers of the segmental apparatus of the spinal cord and formations of the autonomic nervous system, which is necessary for process improvement encontrarnos forming tissue of the vertebral bodies (Yasnohorodska Century A.D., 1987; Gurina A. M., Bagele, E., 1989).2. The use of sub-threshold for muscle contraction force of the current is determined by the data on increasing strength and endurance partijnyh muscles in the treatment of musculoskeletal disorders in the cerebral circulation. The effectiveness of subthreshold stimulation was the il. Vol. 73, March 1992, P. 220-227).3. Electric current frequency of 60-100 Hz, with a pulse duration of 0.5 MS selectively annoying afferent fibers of spinal nerves (Yasnohorodska Century A.D., 1987), which is of special importance in the treatment of DS children. Study of the etiology of DS in recent years confirms the view of the shortage of afferent fibers and the failure of their level of scoliotic deformities (Jankowski A. M., 1993), as well as the value of dysplastic changes of the segmental apparatus of the spinal cord in these patients (Abolmasova E. A. , 1986). Prolonged stimulation of the afferent part of the spinal nerves restores functional deficits of the latter and leads to modulation of proprioceptive information about the position of the spine, coming to the Central system from the area of deformation (Herman R., MixonY., Fisher R. Spine. January-Februaryn, Vol. 10, N 1, P. 1-14.) As a consequence, the normalized downward regulating effect of the Central nervous system to muscle tone and relationship of elements of the spine.Distinctive features of the proposed method is the impact of pulsed current frequency of 60-100 Hz, with a pulse duration of 0.5 MS, low power 5-15 mA subthreshold d is under the level of impaired innervation, defined thermal imaging, EMG methods, as well as the breakdown of the sweating. The use of these features leads to the achievement of the technical result by activating afferent part of the reflex arc at the level of deformation and functions of the autonomic nervous system, and modulation of proprioceptive feelings about body position in space. The above is a fundamentally new etiopathogenetic approach to therapy DS in comparison with the known methods of electrical stimulation on the basis of muscle contraction.Description of method of treatment.The proposed method of treatment consists in electroneurostimulation spinal, including the autonomic nervous formations at the level of paravertebral zones with reduced innervation when using 2 or 4 electrodes depending on their number. Areas disturbed innervation determined before treatment with iodine-starch test Minor and thermal studies on sites with reduced sweating with pale staining and "cold" zones when imaging study. These areas are defined as the levels of reduced electrogenesis paravertebral is depends 60-100 Hz, with a pulse duration of 0.5 MS, amperage 5-15 mA until you feel faint vibration under the electrodes. After selecting zones stimulate the procedure taught by one of the members of the child's family or the medical staff of the hospitals. Is used for the treatment of individual portable 2-channel electrical stimulator domestic production "ATS-100-1". The treatment is carried out at home or in the hospital every day for 6-8 hours in the evening or night for several months. Current gradually increases with decreasing sensations of vibration as a result of adaptation to current. Electroneurostimulation does not require cancellation of other therapeutic treatments of complex conservative treatment of DS. After 6 months of starting treatment parents reported the number of hours spent pacing. After that, there's a traditional x-ray examination of the spine for monitoring the effectiveness of the treatment that is determined by the dynamics of the value of scoliotic deformities and able architectonics, the degree of mineralization of bone tissue of the vertebral bodies, as well as the dynamics of bone age of the child to assess the status of apofisu of the vertebral bodies. In case of suspension of progression and positive dynamics of EN is high and effective. Considering wavy and long-term course of the disease, electroneurostimulation conduct long - until bone maturity tissue of the vertebrae. The next radiographic study determined the merger of Apophis crests of the iliac bones with wings, which corresponds to Riser-4 and testifies to the achievement of bone maturity, electroneurostimulation stops, because in the future the degree of progression of the disease is slowed down considerably and is 1-2oaccording to the method of Cobb annually.An example of the method
Patient Alexander, 13 years old, diagnosis: combined Grodno-lumbar scoliosis III-IV degree, progressive course. The radiological examination in the prone position breast arc was 42o, lumbar -37o; standing 54oand the 39orespectively. The formula for the deformation of the thoracic arc Th4-Th11with top of Th8in the lumbar Th12- L5with top of the L2. The architectonics of the tissue of the vertebrae is determined by labour at the level of the thoracic and lumbar arc, marked osteoporosis, bone age corresponds to 10 years, longitudinal dysplasia of the sacrum, rotary subluxation of C1-C2Sanochnika from level C2to S2. Based on the data of x-ray was appointed ANMS at the level of the lumbar and thoracic arc paravertebral symmetrically with 2 x 4 electrodes. Parameters current: frequency 100 Hz, pulse duration 0.5 MS, current strength 8 mA. The mother of the patient is trained in the methods of electrical stimulation. The treatment was carried out at home daily for 6 h during sleep for 6 months. The control x-ray bone age corresponded to 12 years, osteoporosis decreased significantly, appeared the contours of the bone beams of the vertebral bodies in the thoracic and lumbar arch. After a month the patient the operation was carried stabilization of the lumbar spine using distractor Harrington.Complications during execution of the first phase of the operation and in the postoperative period is not observed. The patient was recommended to continue the treatment method proposed before completion of phase II of the operative correction of scoliotic deformities to prevent further progression of the process. Treatment has improved the process entralgo formation of the vertebral bodies, as well as avoiding complications both during operation and in the postoperative period.Given the short follow-up period at the first stage of treatment (6 months). in many patients and the presence of small quantities of spinal deformity, the objective criterion of effectiveness of treatment, along with the change of angle strain in degrees, is the estimation of the structural changes of the bone tissue of the vertebral bodies according to x-ray examinations. All observed patients showed age, and 27.0% of children this indicator is close to the age norm. Assessment of the effectiveness of treatment has also served on the iodine-starch method research sweating, indicating violation of the autonomic innervation, as it demonstrated a high degree of correlation with x-ray data. The location of the peak deformation and areas of dysplastic changes in the bone tissue completely coincided with the localization of areas of disturbed autonomic innervation and decreased sweating on the iodine-starch test Minor. With significant vegetative disorders, leading to reduction or absence of sweating, there was a strong wedge-shaped deformity of the vertebrae, abnormal rotation, reduction of height of intervertebral disks. At the second stage of the study, which was 6 months, according to regular x-ray noted the absence of disease progression in all observed patients.Thus, conducting daily ANMS for 1 year improves the clinical course of the disease and slows the progression of the degree of deformation by providing a positive influence on the process encontrarnos formation of the vertebral bodies, opei system. A method for the treatment of dysplastic scoliosis in children through exposure to a constant pulse of current, characterized in that the influence exercised by pulse current frequency of 60 Hz and 100 Hz at an amperage of 5 - 15 mA two or four depending on the number of zones of innervation disorders electrodes paravertebral within 6 to 8 hours during the night, every day, before the onset of maturation of bone tissue of the vertebral column in the background of a traditional complex of conservative treatment.
SUBSTANCE: method involves applying transscleral diaphanoscopic examination method for adjusting intraocular neoplasm localization and size. Rectangular scleral pocket is built 2/3 times as large as sclera thickness which base is turned from the limb. Several electrodes manufactured from a metal of platinum group are introduced into intraocular neoplasm structure via the built scleral pocket. Next to it, intraocular neoplasm electrochemical destruction is carried out in changing electrodes polarity with current intensity of 100 mA during 1-10 min, and the electrodes are removed. Superficial scleral flap is returned to its place and fixed with interrupted sutures. 0.1-2% aqueous solution of khlorin as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, is intravenously introduced at a dose of 0.8-1.1 mg/kg. Visual control of intraocular neoplasm cells is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, transpupillary laser radiation of 661-666 nm large wavelength is applied at a dose of 30-120 J/cm2. the operation is ended with placing sutures on conjunctiva. Platinum, iridium or rhodium are used as the metals of platinum group. The number of electrodes is equal to 4-8. 0.1-1% khlorin solution, selected from group containing photolon, radachlorine or photoditazine, is additionally repeatedly intravenously introduced in 2-3 days at a dose of 0.8-1.1 mg/kg. Visual control of intraocular neoplasm cells is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, repeated laser irradiation of the intraocular neoplasm is carried out with radiation dose of 30-45 J/cm2.
EFFECT: complete destruction of neoplasm; excluded tumor recurrence; reduced risk of tumor cells dissemination.
3 cl, 3 dwg