A method for the treatment of peripheral nervous system in patients with gunshot wounds and combat injuries
(57) Abstract:The invention relates to trauma and is intended for treatment of peripheral nervous system in patients with gunshot wounds and combat injuries. Impact of interference currents on the affected limb, applied to the affected area with the help of intersecting pairs of electrodes. Electrodes are placed on the affected limb, regardless of the lesion in the area of innervation of the damaged nerve and segmental-reflex zone corresponding to the damaged limb. During one procedure is to first have an impact on the corresponding segmental-reflex area and then the area of innervation of the damaged nerve by the duration of the procedure 10-15 minutes on each field. The impact of the interference currents on the affected limb exercise four pairs of cooperating electrodes, two of which are placed on the upper segment of the limb, and the other two pairs on the lower segment. Additionally, during the presence of pain treatment of injuries of peripheral nerves and plexuses first 3-4 days is carried out in the frequency range 0 - 100 Hz, and then continue treatment at frequency 0 - 10 the mi wounds and combat injuries. 3 C.p. f-crystals, 2 ill., table 1. The invention relates to medicine, namely to physiotherapeutic methods of treatment of patients with gunshot wounds and combat trauma of peripheral nerves and plexuses.Gunshot wounds and combat injuries (RR and BT) peripheral nerve and plexus systems stand out among other injuries complexity of the lesion and severity. The observed symptom motor, sensitive, vegetative trophic disorders in the PR and BT remain for a long period of time, in many cases, lead to long-term disability, and in 29-60% of cases of disability, and sometimes even irreversible. Therefore, the development of more effective treatments for patients with PR and BT peripheral nervous system, contributing to the reduction of treatment time, more complete recovery of lost functions, reduction of percentage of disability is an important task of modern balneology and physiotherapy.Restorative treatment of patients with peripheral nerve injuries is carried out in stages. Failure of the integrity of the nerves and vnutrostatnych lesions - surgical intervention, made geologicheskiy treatments rarely lead to the recovery of lost functions. The use of physical therapy and conducting reconstructive surgery reduces pain and swelling of the soft tissues, improves microcirculation, eliminates inflammation and ischemic phenomenon that contributes to the acceleration of reparative processes and the regeneration of nerve fibers.There is a method of treatment of traumatic injuries to the nerves of the limbs by electrophoresis centrifugate sapropel, which is the effect of galvanic current in the course of damaged nerve lasting 30-35 min for one procedure with a total of 20-30 procedures (E. A. Korotkevich and other Remedial treatment in the early period of traumatic nerve lesions of the upper extremities. - Step recovery treatment of diseases and injuries of the peripheral nervous system. - Stavropol, 1987, S. 196 to 199).The disadvantages of this method is the duration of treatment and its lack of effectiveness, weak stimulating effect of galvanic current on the neuromuscular apparatus, and therefore the medical complex is usually supplemented by electrical stimulation of degenerative muscle, which also leads to neznachytelnaya nerves using an ITC-sinusoidal modulated currents (R. A. Chilingaryan, etc. CMT-gel trypsin in complex treatment of patients with traumatic injuries of peripheral nerves. - Questions of balneology, physiotherapy and physical therapy, 1986, 4, S. 23-25). This method is based on the use of pulsed low-frequency current-CMT generated by the "Amplipulse" in an extended mode.The disadvantages of this method is intactness corresponding to the defeat of the segmental areas when exposed, lack of stimulating effects on the neuromuscular system, a small percentage efficiency (48%). In addition, the complexity and severity of the damage, in particular when the PR and BT peripheral nerves, the presence in many cases of foreign bodies in the form of fragments in the damage zone limit wide application of this method.The closest technical solution (prototype) is a method of treating neuromuscular system of the patient interference currents generated between the two pairs of electrodes placed on the injury, with subsequent impact of this current in discontinuous mode and a frequency of from 0 to 10 Hz, and when pain syndrome - from 50 to 100 Hz, while the impact for 10-15 minutes for procedure 1, with a total number of 10-II. - Minsk: Belarus, 1986, S. 141-151). The effect of the current render directly to the affected area of the body.The disadvantage of the prototype is that impact directly on the affected area due to weak irritants interference currents leads to reduction of therapeutic efficacy in the treatment of injuries of the peripheral nervous system, because it does not have effective impacts on related neuromuscular patterns in General and in the field of wound quickly develops a tolerance to interference currents.The task of creating the present invention is to provide a method of treatment of patients with gunshot wounds and combat injuries of peripheral nerves and plexuses, as well as injuries of any nature, resulting in damage to the peripheral nerve, which allows using the soft nature of the impact of interference currents, to provide a high treatment effect.The solution of this problem is achieved by the fact that in the known method, including placing on the affected limbs of the two pairs of electrodes for stimulation interferential currents in intermittent mode frequency 0-10 Hz, and at more than the 15 min with the total number of 10-15 procedures daily or every other day, intersecting pairs of electrodes on the affected limb is placed regardless of the location of the lesion in the area of innervation of the damaged nerve at shoulder and forearm with lesions of the nerves of the upper limb, the thigh and the lower leg - lower extremities), in addition, by placing overlapping pairs of electrodes on yenesay-Wernigerode and lumbosacral spine affected by interference currents specified mode on the corresponding segmental-reflex zones.During one procedure is to first have an impact on the corresponding segmental-reflex area and then the area of innervation of the damaged nerve, 10-15 min on each field.The impact of the interference currents on the damaged limb by four pairs of influencing electrodes, two pairs of which are placed on the upper half of the limb, and the other two pairs on the bottom.However, the presence of pain treatment of patients with injuries of the peripheral nervous system the first 3-4 days is carried out with an extended frequency range from 0 to 100 Hz, and then continue treatment at a frequency of from 0 to 100 Hz.Called interferencelimited, the nerve endings and muscle fibers, which leads to muscle contraction. Realizing the impact on advanced zones - i.e. both halves of the affected limb, and not only directly in the affected area, achieve improvement of peripheral blood circulation, functional state of the neuromuscular system, have pain and reduce the swelling of tissues to the action. In addition, interference currents do not have contraindications with the presence of foreign bodies in the body, which often happens with combat wounds.The impact on the corresponding segmental-reflex zone (upper extremities is nigricana and vernerova paravertebral area, and for the lower - lumbar-sacral spine), which is key in the management of the extremities, provides greater influence on the segmental structure of the neuromotor apparatus and thereby furthering the recovery of lost functions.Implementation impacts during one procedure, first the corresponding segmental-reflex area and then the area of innervation of the damaged nerve allows you to cover both the segmental structure, and damaged nerve mytechnologyyy currents on the affected limb by the four pairs of electrodes, placed on the upper and lower limb segments, increases the efficiency effects due to the expansion of the area the impact on the affected limb, which significantly affects the duration of treatment and resistance of the obtained results.Implementation in the first 3-4 days of exposure in the extended frequency range from 0 to 100 Hz if the patient's pain syndrome provides relief of pain with the simultaneous implementation of therapeutic effects, and the subsequent transition to the frequency 0-10 Hz provides a profound stimulatory effect on neuromuscular patterns that significantly enhances therapeutic effect.The claimed solution is illustrated by the attached sketches, where Fig.1 shows an embodiment of the inventive method in the treatment of upper extremity, and Fig.2 - bottom.On these figures, positions 1 and 2 show first and second pairs of electrodes placed on the body of the patient so that the current passing electrical currents overlap in the area under consideration impact. Position 3 indicates segmental-reflex zone (Fig.1 - top, and Fig. 2 - bottom). Position 4 indicates the area of innervation of the damaged nerve southwestfinancialsee currents carry out, for example, by means of the apparatus Interdean-IDM" (Poland) two or more pairs of electrodes. Patient laid on the couch in a comfortable position. Two pairs of electrodes 1 and 2 are placed in segmental-reflex zone and is affected by interference currents with a frequency 0-10 Hz, and when pain syndrome - the first 3-4 days with frequency 0-100 Hz, for 10-15 minutes, then place four pairs of electrodes directly to treat the two pairs of legs on each half (for the upper limb is the shoulder and forearm, and lower thigh and drumstick), and make the impact in the same mode for 10-15 minutes Similar procedures carried out daily or every other day for 10-15 procedures of treatment.The proposed method is tested in the neurological Department of the research Institute of medical rehabilitation and natural therapeutic factors of 48 patients with gunshot wounds and combat injuries of peripheral nerves, and after various reconstructive surgeries on this occasion.The observed patients were men aged from 20 to 43 years. Lesions of the nerves of the upper limb (brachial plexus, median, ulnar and radial nerves) were in 32 patients, lower limbs (hips woven affected vessels and nerve trunks were made for 15 people.At admission, the patients complained of violations of motor activity, weakness and weight loss muscle pain, paresthesia and numbness. In neurological status had a motor, sensitive, reflex, autonomic-vascular and trophic disorders of various degrees and the old injury.Severity of damage to the nerve trunks patients were distributed as follows: a concussion is diagnosed in 21 patients, the injury - in 16 and full anatomic break - in 11 patients. 10 patients had a concomitant traumatic brain injury with concussion or brain injury and in 12 patients - contracture of the various joints of the affected limb.All observed patients was well tolerated procedure in accordance with the proposed method. Negative effects from underlying and concomitant diseases were observed. Under the influence of the treatment in 65% of cases decreased pain intensity, in 58% of cases decreased vegetative-vascular and trophic disorders, increased muscle mass, in 55% of cases increased volume of active and passive movements, and 20% - narrowed area sensitive disorders.Below, in the table, previdenziali therapeutic effect was observed in 81% of cases, that is significantly higher than when using known methods.The high efficiency of the inventive method is also confirmed by the results of functional methods of research.According to electroneuromyography after treatment with interferential currents was observed a statistically significant increase in the maximum amplitude of the M-response of the muscles of the foot (with 466,686,0 to 748,032,0 µv; P<0.02) and brush (with 2406,6496,0 to 3780,0300,0 µv; P<0,02). The speed of conduction of impulses at the end of treatment was increased by the ulnar nerve (32,61,6 to 42,91,7 m/s; P<0,05) and tibial nerve (17,70,6 to 25,53,3 m/s; P<0,02). Along with this there was an increase in the number of functioning motor units, which was highly reliable in the muscles of the hand (P<0,001).Reovazograficheskie studies revealed improvement of peripheral blood circulation, which was reflected in the but the of Reznikov, increasing the intensity of blood. This is evidenced by the increase in the amplitude reovazograficheskie waves (with 0,050,002 Ω to 0,070,003 Ω; P<0,05).Below we give examples of specific use of the claimed method.Example 1. Patient Ismailov, E. I., 1959 R., East. bol. 924. Diagnosis: effects of fire a blind shot in the right hip with damage to the sciatic nerve paresis of the right foot.Complaints for admission to numbness and weakness in my right foot, impaired walking, loss of muscles of the right femur and tibia, pain in the right foot, aggravated by motion.Sick in may 1992 he received a gunshot gunshot wound in the upper 1/3 of the right hip during the military action.Neurological status: cranial nerves without pathology. The patient walks with a walking stick, while the right foot is hanging (stepper). Limited on the femur and tibia at 4-5 cm less than the right. Muscle tone reduced the extensor tendon of the right foot, their muscle power reduced to 3 points. Tendon and periosteal reflexes of the upper extremities live, knee reflexes alive, even. Ankle reflex on the right is missing. Pain anesthesia in the area of the big toe of the right foot and hypoesthesia in the external-side surface of the right tibia. The right foot is cold to the touch, pale color.The patient received interferential currents paravertebral lumbar-sacral spine, right thigh and drumstick in broken-rhythm mode the first 3 days frequency 0-100 Hz, and from the 4th day 0 -10 Hz 10 min in each field every day for 10 days.Treatment the patient underwent fine. After treatment extensor movement in the ankle joint of steel in full. Decreased pain intensity, increased muscle strength in the extensor tendon of the right foot, narrowed area gipestesia, and the area of anesthesia were not found.Positive dynamics was observed in the characteristics of functional methods of research. Bioelectric activity was increased in the anterior tibial muscle from 150 to 250 µv. The amplitude of the muscle response with short rathgeb the conduct of the pulse was increased by peroneal nerve from 41.7 to 45.8 m/s, and tibial - from 37.6 to 39.5 m/s According to the days, there was an increase in the intensity of blood and reduction of the asymmetry factor.The result of treatment is a significant increase. Remote observations of 6 months and 1 year showed that locomotor activity was restored, violations disappeared, the patient walks without a cane.Example 2. Sick of Nazarmamedov H. A., 1975, R., East. bol. 1499. Diagnosis: military-traumatic lesion of the left brachial plexus total character, paresis of the left upper extremity, late recovery period.Interference currents paravertebral on yenesay and Wernigerode spine, left shoulder and forearm in jerky rhythmic mode frequency 0 -10 Hz 10 min in each field every day for 10 days.Treatment the patient underwent fine. After treatment of active movement recovered in the left wrist, the elbow and the fingers of the left hand. Muscle strength increased in the brush, narrowed area gipestesia, recovered discriminatory sensitivity.According to electroneuromyography showed a significant increase in the amplitude of muscle re the s pulse motor fibers of the median and ulnar nerves.Treatment the patient has completed a significant improvement. Re-examination after 1 year showed further recovery of lost functions in the period after treatment.As can be seen from the above, the proposed method enables to achieve a high therapeutic effect and can be used for the treatment of patients with gunshot wounds and combat injuries of the peripheral nervous system, as well as after reconstructive operations on this occasion. The use of this method reduces the time of treatment, restore lost functions and reduces the percentage of disability of young people of working age. 1. A method of treating patients with gunshot wounds and combat injuries of peripheral nerves and plexuses, including the effects of interferential currents on affected limb supplied with mutually intersecting pairs of electrodes, wherein the four pairs of electrodes are placed in the area of innervation of the damaged nerve on the affected limb, regardless of the lesion, as well as in addition to segmental-reflex zone corresponding to the damaged limb.2. The method according to p. 1, characterized in that the% is on the area of innervation of the damaged nerve by the duration of the procedure 10-15 minutes on each field.3. The method according to PP. 1 and 2, characterized in that the impact of interference currents on the affected limb exercise four pairs of cooperating electrodes, two of which are placed on the upper segment of the limb, and the other two pairs on the lower segment.4. The method according to PP. 1-3, characterized in that in the presence of pain treatment of injuries of peripheral nerves and plexuses first 3-4 days is carried out in the frequency range 0 - 100 Hz, and then continue treatment at frequency 0 - 10 Hz.
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