A method of evaluating the effectiveness of remedial measures in the process of medical rehabilitation of patients with degenerative-dystrophic diseases of the hip joint
The invention relates to medicine and can be used by doctors orthopedagogiek clinics. The method is carried out by taking the patients blood before and after the course of medical procedures, serum define the content of glycosaminoglycans in the case of the original values of the analyzed parameters above 0,086 g/l when it is less reduction of this magnitude after treatment or if the original parameter values below 0,038 g/l with the increase after treatment, more of this magnitude conducted remedial measures assessed as effective. Technical result: simplification of the procedure of examination of patients, increasing objectivity and diagnostic value judgments about the effectiveness or lack of effectiveness of therapeutic measures for patients suffering from chronic diseases of the musculoskeletal system.
The invention relates to medicine, more specifically to methods of evaluation of the results of therapeutic interventions on the stages of medical rehabilitation of patients with long-term suffering from various diseases degenerative-dystrophic musculoskeletal, and motivitation to assess the effectiveness of therapeutic measures, development strategy and plan corrective therapy in the appointment of repeated cycles of rehabilitation.
Criteria based on which the Clinician can make a judgment about high or low effectiveness of the course of treatment measures that are largely subjective from both the patient and the attending physician (complaints and emotional state of the patient, the severity of pain, the support function of the lower extremities, endurance, musculoskeletal load, the nature of the gait, the results of visual inspection and palpation of the joints and so on). The objective, but to a certain degree indirect criteria for the assessment of musculoskeletal system are the results of measurements, including goniometry, dynamometry, local thermometry, as well as some laboratory parameters - determination in blood leukocytes, alpha2-globulin fraction, C-reactive protein, immunoglobulins of different classes, fibrinogen, erythrocyte sedimentation rate, some other indicators). However, the results of these methods do not reflect state-specific metabolic processes occurring in p patients allows only indirectly to judge the effectiveness or ineffectiveness conducted remedial measures. In addition, the physician has to assess the patient's condition based on aggregate results of different non-specific methods that contributes to a certain extent, an element of subjectivity, especially in cases where there are multidirectional shifts some laboratory parameters.
Closest to the proposed technical solution is the laboratory method of biochemical analysis the blood of patients and on the basis of the results of the assessment of patients and the effectiveness of remedial measures (Tolmachev A., et al. A method of evaluating the effectiveness of treatment of orthopedic and traumatological patients // VII Congress of traumatologists and orthopedists Russia. Proc. Dokl. 2 so / Ed. by N. G.Fomicheva. - Tomsk, 2002. - T. 1. - S. 489).
The method of evaluating the effectiveness of remedial measures in relation to orthopedic and traumatological patients proposed by A. K. Tokmachev et al., is determining the estimated value (ratio) on the basis of which to assess the outcome of treatment. Calculations To pre-determine the intensity of the chemiluminescence total lip is high-density (HDL). In addition, plasma examine the number of enzyme-active ceruloplasmin.
However, this method has drawbacks. Determining the level of oxidant-antioxidant balance in blood plasma is not a direct test for the assessment of metabolic processes in pathological lesion (bone-cartilage system affected limb). He only indirectly reflects the intensity of reparative processes in the body. Furthermore, the method developed by A. K. tukmachev et al., is extremely time-consuming (long process of separation of different density lipoproteins, registration of ultra-weak luminescence samples lipids, determination of ceruloplasmin) and inaccessible to ordinary medical institution, as it requires the separation of LDL and HDL fractions for subsequent chemiluminescent analysis of the samples lipids that involves the use of unique and expensive equipment (high-speed ultracentrifuge for differential ultracentrifugation, high-sensitivity chemiluminometer - equipment of foreign manufacture).
The present invention is the simplification of the procedure of examination of patients, increasing obih events for patients, stratakis chronic diseases of the musculoskeletal system.
This problem is solved due to the fact that the blood of patients carried out before and after the course of medical procedures, in serum samples to determine the content of glycosaminoglycans in the case of the original values of the analyzed parameters over 0,086 g/l when it is less reduction of this magnitude after treatment or if the original parameter values below 0,038 g/l with the increase after treatment, more of this magnitude conducted remedial measures assessed as effective.
The method is as follows.
In patients with long current chronic diseases of musculoskeletal system (coxarthrosis, aseptic necrosis of the femoral head, degenerative lesions of the hip joint with racemose restructuring) before and after the course of treatment measures from a vein to take blood, separate the serum and in the latter determine the content of glycosaminoglycans using known techniques (Kamyshnikov B. C. Handbook of clinical-biochemical laboratory diagnosis: 2 so-So 2 - Mn.: Belarus, 2000. - 463 C.). Compare the values of the analyzed parameters of the patient to 0,086 g/l when it is less reduction of this magnitude after treatment or if the original parameter values below 0,038 g/l with the increase after treatment, more of this magnitude conducted remedial measures assessed as effective. At other values of the analyzed parameters to the course of medical procedures and other parameter changes after treatment judgment about the effectiveness or lack of effectiveness of rehabilitation measures is uncertain. In this case, the evaluation of the effectiveness of the treatment by a medical practitioner based on the aggregate results of other examinations of the patient listed above.
The basis for the development of the proposed method of assessing the effectiveness of treatment of degenerative-dystrophic diseases of the musculoskeletal system were the results of a survey of patients with rehabilitation in a specialized rehabilitation clinic Nizhny Novgorod research Institute of traumatology and orthopedics. Complex medical event that patients received during 3-4 weeks, included drug therapy, physiotherapy, acupuncture, swimming pool, massage, various physiotherapy.
Before and after treatment in the blood of patients was determined by the content of glycosaminoglycans and evaluated the results of the study. The concentration of glycosaminoglycans were studied in 58 Balanov was 0,062±0,0057 g/l (M±m, where M is the arithmetic mean, m is the average error of the arithmetic). Within optinally (M±0,67 b, where b is the standard deviation) of the analyzed trait under controlled conditions varied within 0,0381-0,0859 g/l (0,038-0,086 g/l).
Patients with degenerative-dystrophic diseases of the musculoskeletal system were divided into 3 groups depending on the change direction of the content of glycosaminoglycans after the treatment. The first group consisted of patients (24 patients), which initially (prior to the course of rehabilitation measures) concentration of glycosaminoglycans exceeded the level of optinally and was within 0,112±0,0060 g/l (M±m). However after a course of remedial measures the concentration of glycosaminoglycans in the blood of these patients was decreased to the level 0,062±0,0057 g/l (m±m). The difference between the average values of the analyzed parameters before and after treatment of patients was statistically significant with a high degree of confidence (p<0,001).
Patients of the second group (26 patients) had initially low levels of glycosaminoglycans (0,046±0,0045 g/l; M±m), the concentration of which increased significantly after treatment (0,094±0,0050 g/l; M±m). Ratlesnake (p<0,001). In patients of the third group (8 persons) the content of glycosaminoglycans in the serum after a course of remedial measures has not changed (0,087±0,0190 g/l source data; 0,087±0,0186 g/l after treatment).
The foregoing suggests that, prior to a course of remedial measures features of the metabolic processes in the affected tissues, bones and joints of patients vary, and treatments have distinct normalizing effect that is accompanied by a change in the blood levels of glycosaminoglycans and bringing them to the level of the reference value.
This interpretation of the obtained results finds the explanation from the position of modern ideas about the pathogenesis of degenerative-dystrophic diseases of musculoskeletal system and understanding of metabolic changes in the affected tissues (N. Kornilov.N. et al. Current views on the pathogenesis, principles of diagnosis and conservative treatment of degenerative-dystrophic diseases of the knee joint // Traumatology and Orthopaedics, Russia, 2002. - N 2. - S. 47-59). In the early stages of the degenerative process catabolism of proteoglycans chondrocytes sharply activated, the products of their degradation (generoulsy proliferation of chondrocytes and active products of the components of the matrix. Based on these representations, it should be assumed that patients who have initially (before treatment) high levels of glycosaminoglycans, the pathological process is at this phase of development. As shown by our study, patients with baseline serum glycosaminoglycans was increased (0,101±0,0098 g/l; M±m), suffered severe pain, at that time, as the value of this indicator within 0,064±0,0065 g/l; M±m), pain was less pronounced. The difference of average values of the analyzed parameter is statistically significant (p<0,01). The complex of rehabilitation measures is accompanied by a decrease in blood glycosaminoglycans that, therefore, reflects the decrease in the activity of the pathological process and proves the positive effect of treatments.
With further progression of the pathological process of the separation of the reaction become defective, anabolic and catabolic processes in the area affected tissues desynchronizers changing range of proteoglycans, decreased synthesis of glycosaminoglycans and, accordingly, their entry into the bloodstream. You can put that in patients with the on-cartilage tissues pathologically altered limbs are in the phase of maladjustment, and backup capabilities of metabolic processes in bone and articular apparatus is reduced. After the conducted treatment measures - stimulation of metabolic processes in the organism of patients, including locally - in the area of the affected bone and cartilage tissue synthesis of glycosaminoglycans increases, their content in the blood flow is restored to normal.
The above formed the basis for the interpretation of the results of determination in blood content of glycosaminoglycans and assess the effectiveness of therapeutic interventions in patients suffering from chronic degenerative-dystrophic diseases of the musculoskeletal system.
A retrospective analysis of the results of examination of patients and evaluation of the suitability of the proposed test showed the following. Of the 24 patients of the first group, which, after the treatment the content of glycosaminoglycans decreased from 21 patients before treatment the analyzed parameters was more 0,086 g/l After completion of the cycle of rehabilitation measures in 20 of 21 patients, the concentration of glycosaminoglycans was below 0,086 g/l In 1 patient of 21 patients after treatment indicator decreased slightly and was higher 0,086 g/l
Out of glycosaminoglycans increased) in 11 patients the initial values of the analyzed parameter was less of 0.038 g/l, at that time, as in 15 patients - more of 0.038 g/l After treatment, all patients whose blood concentration of glycosaminoglycans was less of 0.038 g/l (11 patients), analyzed exceeded the level of 0.038 g/l
Patient III-EA I. C., 45 East. b-nor N 203776), enrolled in the Department of rehabilitation Nizhny Novgorod research Institute of traumatology and orthopedics (owl NIETO) with a diagnosis of aseptic necrosis of head of left femur IV century with severe pain. The content of glycosaminoglycans in the serum before the start of rehabilitation measures - 0,136 g/L. After a course of complex treatment conducted within 4 weeks (drug, kineso and physiotherapy), the level of glycosaminoglycans in the serum decreased to 0,073 g/l On the basis of the result of the content in the serum glycosaminoglycans made a conclusion about the effectiveness of medical procedures that are consistent with the overall status of the patient at discharge from the hospital.
Patient 3-VA E. P., 24 (East. b-nor N 203734), was for 3 weeks in-patient treatment in owl NIETO about bilateral dysplastic Cox is likenov before the start of the course of medical procedures (0,023 g/l) and after a course of conservative treatment (0,050 g/l), including drug therapy (sirdalud, goal-T, b vitamins, nicotinic acid), physical therapy (massage, hydro massage, phonophoresis of hydrocortisone, spectrotemporal muscles) and physiotherapy identified the increasing concentration of glycosaminoglycans in the serum to optinally. According to the results of the comparative evaluation of the content of glycosaminoglycans before and after treatment concluded about the effectiveness of rehabilitation measures. The patient was discharged from the Institute with a significant improvement of the General status and local status.
Patient B-VA, M. C., 42 (East. b-nor N 203766), was in the month of inpatient treatment for bilateral dysplastic coxarthrosis III century with chistovodnoe reconstruction of the articular ends and severe pain. The level of glycosaminoglycans in the serum before treatment of 0.133 g/l After the course of treatment, including drug therapy (Movalis, sirdalud, aevit, goal-T, b vitamins, Actovegin), physical therapy (massage, hydro massage, amplipulse therapy and kinesiotherapy, the content of glycosaminoglycans declined slightly (0,100 g/l), but did not reach the level of optinally. Financial p which can be used to assess the effectiveness of therapeutic measures in patients with degenerative-dystrophic diseases of the hip joint, the technique for assessment of patient outcomes are for sale in any clinical diagnostic laboratories, as it does not require special analytical equipment is scarce and expensive reagents. The proposed method allows the physician to a Clinician in the shortest possible time to evaluate the condition and the severity of the pathological process in bone and cartilage tissues of the affected limbs, to develop a plan for a complex of therapeutic measures to objectively evaluate the results and determine future strategy in the rehabilitation of patients. The test may also be recommended not only as an independent, but also for use in combination with other methods of examination of patients with this pathology.
A method of evaluating the effectiveness of remedial measures in the process of medical rehabilitation of patients with degenerative-dystrophic diseases of the hip joint, including blood collection and separation of serum, wherein the blood sampling carried out before and after the course of medical procedures, in serum samples to determine the content of glycosaminoglycans in the case of the original values of the analyzed parameters above 0,086 g/l at its lower after Les which were carried out medical activities assessed as effective.
FIELD: medicine, psychiatry.
SUBSTANCE: one should isolate DNA out of lymphocytes of peripheral venous blood, then due to the method of polymerase chain reaction of DNA synthesis one should amplify the fragments of hSERT locus of serotonin carrier gene and at detecting genotype 12/10 one should predict the risk for the development of hallucino-delirious forms of psychoses of cerebro-atherosclerotic genesis.
EFFECT: more objective prediction of disease development.