Multi-channel electroneurostimulation method for treating lumbar osteochondrosis patients after replacing intervertebral disks with prostheses

FIELD: medicine.

SUBSTANCE: method involves applying stage-by-stage trunk lower extremity muscles electrostimulation with rectangular pulses sequentially in three zones. The first zone is composed of symmetric sacrospinal and gluteal muscles. Healthy extremity muscles belong to the second zone. Diseased extremity muscles belong to the third zone. The treatment is alternated with tibial and fibular nerve electrostimulation. Quadriceps and biceps muscle of thigh, anterior tibial muscle and triceps muscle of calf are the lower extremity muscles under stimulation.

EFFECT: enhanced effectiveness of multi-channel electroneurostimulation.

5 cl, 2 dwg, 2 tbl

 

The invention relates to medicine, namely to orthopedics, and can be used for the rehabilitation of patients with osteochondrosis of the instability of the lumbar motor segments and disco-radicular conflict after surgery prosthetic intervertebral discs.

There is a method of multichannel electroneurostimulation with the peripheral paresis and paralysis (Zavialov AV, Affectionate V.B. have been Methods and neurophysiological rationale for the combined multi-channel electroneurostimulation with the peripheral paresis and paralysis / Issues balneology, physiotherapy and culture), No. 3., 1984, S.11-13), including a consistent effect on the injured nerve and paretic muscles that promotes the restoration of nerve trunks and the devolution of destructive changes in the muscles.

However, in the known method the impact of exercise on only one affected nerve innervated them muscle and impossible to influence a large group of muscles and nerves at the dysfunction of the musculoskeletal system in patients with lumbar osteochondrosis with instability of the lumbar motor segments following replacement of intervertebral discs.

The technical problem is to accelerate restoration of the functional state of the musculoskeletal system in patients with osteochondrosis with n the stability of the lumbar motor segments and disco-radicular conflict after surgery prosthetic intervertebral disks is solved as follows.

In the method of multichannel electroneurostimulation in patients with lumbar osteochondrosis after implantation of the intervertebral discs, includes separate electrical stimulation of nerves and muscles, according to the invention carried out a phased electrical stimulation pulses of rectangular shape of the muscles of the trunk and lower extremities sequentially in three zones: the first zone is symmetric crestronitalia and glutes, the second zone - the muscles of the healthy limb, the third zone - the muscles of the affected limb, alternating with electrical stimulation of the peroneal and tibial nerves, when stimulated muscles of the lower extremities are the quadriceps and biceps muscle of the thigh, anterior tibial muscle and triceps tibia. At the first stage, the stimulation of only the muscles of the trunk and lower extremities, in the second stage stimulation symmetric christofascist and gluteal muscles alternate to the stimulation of the peroneal and tibial nerves, in the third phase, the stimulation of the muscles of the trunk and lower extremities alternate to the stimulation of the peroneal and tibial nerves. When bilateral radicular syndrome second area muscles are less affected limb; the third area - the muscles most affected limb.

The choice of the muscles of the trunk and lower extremities, peroneal and Bolshie novogo nerves to electrical stimulation caused the greatest impact on physiological functional state of the musculoskeletal system.

The choice for the stimulation of muscles and nerves impulses of rectangular shape in comparison with other forms of pulses due to the fact that they are the most adequate physiological processes in the neuromuscular apparatus for recovering their functional status. Phased electrical stimulation of the muscles of the trunk and lower extremities in alternation with the stimulation of the peroneal nerve and tibial nerves after surgical treatment conducive to accelerating the recovery of the functional state of the musculoskeletal system, which has been proved in clinical data, electroneuromyographic and complex biomechanical studies, conducted on 15 patients with osteochondrosis of the lumbar motor segments with instability and disco-radicular conflict. In tables 1 and 2 presents the dynamics of the recovery of the functional state of musculoskeletal patients after surgery intervertebral disc without the use of electroneurostimulation (ENMS) - control group and using ARMS in the early recovery period.

In the control group, 6 patients (40%) one year after surgery complained of persistent numbness in the foot, the sensitivity of the limbs to the cold, and in the group of patients who were e is chronilogically - these symptoms disappeared within 3 months after surgery and at follow-up, when observing during the year was not renewed.

Table 1

The dynamics of the recovery of the vertical support reactions of the foot (in % of body weight).
GroupNormaTime studies
Before surgery3 months after surgery6 months after surgery12 months after surgery
Prosthetic intervertebral discs109±0,2102,4±0,6103,8±0,8105,4±0,7107,6±0,5
Prosthetic intervertebral discs + ANS109±0,2102,6±0,4105,8±0,6108,4±0,4108,9±0,3
Table 2

The dynamics of the recovery indicator integrated bioelectric activity of the middle gluteal muscle (m. glutaeus medius) during double-step (in mV) on the side of radicular syndrome.
GroupNormaTime studies
Before surgery3 months after surgery6 months after surgery12 months after surgery
Prosthetic intervertebral discs15,3±1,29,6±1,110,5±1,411,7±0,8the 11.6±0,7
Prosthetic intervertebral discs + ANS15,3±1,29,8±0,913,6±0,815,4±0,615,1±0,6

Main indicators of the temporal, spatial, kinematic, dynamic (table 1) and electromyographic (table 2) parameters distance in the first group reached normal values after 6 months and was maintained through 1 year after surgery. In the control group these values were improved by the date 1 year after surgery, not reaching normal values.

Thus the use of the proposed method of electroneurostimulation in patients with lumbar osteochondrosis after prosthetic intervertebral discs contributes to the early and complete restoration of the functional state of the musculoskeletal system.

The present invention is as follows.

7-10 days after surgery, prosthetic intervertebral discs begin the course e is christiantiy, consisting of 12-15 daily sessions using multi-channel electrical stimulator that generates pulses of rectangular shape, for example Bioritm-04. The position of the patient on the couch lying on his stomach in a convenient position.

The first stage of the three treatments. In the first procedure consistently affect the muscles of the trunk and lower extremities, divided into 3 zones. The total duration of the session of electrical stimulation is 60 minutes on 20 minutes on each area. Electrodes made of carbon fabric picked individually, taking into account the transverse dimensions of the muscles that are subject to stimulation. The arrangement of the electrodes for electrical stimulation of muscles is shown in figure 1: a - front view, b - back view. 1 - Krestovskiy muscle; 2 - big and middle gluteal muscle; 3 - the quadriceps muscle of the thigh; 4 - anterior tibial muscle; 5 - two-headed muscle of femur; 6 - triceps tibia.

The electrodes are fixed on the surface of the body by means of the clamping manzhetok. Active electrode (A) install the motor area of the muscle, the indifferent electrode (S) placed at a distance of 4-8 cm from the active.

The first zone is symmetric crestronitalia 1 and glutes 2. Current 15-20 mA (tangible, but painless reduction), frequency of 70 Hz. Now make tutus pulses of 2 seconds, the interval between sent packets - 2 sec.

Second AOR is and impacts - muscles healthy, and with bilateral radicular syndrome are less affected lower limbs (quadriceps 3 and biceps femoris 5, anterior tibial muscle 4, triceps tibia 6). Current 15-20 mA (tangible, but painless reduction), frequency of 70 Hz, the time of sending packets of pulses is 4 seconds, the interval between sent packets - 4 sec. Muscles are stimulated alternately, first muscle 3, 4, then the muscles 5, 6.

The third area of impact - muscle of the patient, and with bilateral radicular syndrome more affected lower limbs (quadriceps 3 and biceps femoris 5, anterior tibial muscle 4, triceps tibia 6). The stimulation parameters are similar as in the second zone of influence.

Over the next two days of conducting the electrical stimulation of muscles in the same sequence. The current strength during this gradually increased: at the second session of up to 40 mA, and the third and subsequent sessions to 45-50 mA. Considering the individual tolerability of the patient, on the third and subsequent sessions, the amperage can be left at the level of the second session - up to 40 mA.

The second phase alternating stimulation of muscles and nerves includes one-fourth of the procedure. Where electrical stimulation of the muscles of the first zones alternate with electrical stimulation of nerves. The locations of the electrodes on the body of the patient for electrical stimulation of nerves to depict Alena figure 2 a - front view; b - rear view. 1 - the area of the popliteal fossa; 2 - the area behind the inner ankle; 3 - zone of the rear foot.

First act on symmetric crestronitalia and gluteal muscles for 20 minutes, then transferred to the neural stimulation, which begin with healthy nerve trunks (with bilateral radicular syndrome is less affected lower limb. The indifferent electrode (S) impose paravertebral lumbar-sacral region. Active electrode (A) are placed alternately in three points: 1) in the popliteal fossa to the area of the most superficial location of the tibial and peroneal nerves, 2) behind the medial ankle area the most superficial location of the tibial nerve, 3) on the rear of the foot in the area of the most superficial location of the fibular nerve.

The time of stimulation at each point for 5 minutes. The pulse current of rectangular shape with an amplitude of 15-20 mA and smoothly varying the frequency from 20 Hz to 120 Hz, the period of 4 sec.

After this exercise, electrical stimulation of nerve trunks opposite sore limbs (bilateral radicular syndrome is more affected lower limb) on the diagram above.

At the last stage of stimulation until the end of the course the alternate procedure for the third and fourth day.

Example. Bo the other X., 38 years old, was admitted to the neurosurgery ward No. 15 Sverdlovsk regional clinical psychoneurological hospital of war veterans complaining of back pain, aggravated by physical activity and radiating on the anterolateral surface of the right femur and tibia, numbness in the area of the rear foot, the constant feeling of "coldness" in the affected limb.

Objectively: the patient's normal body composition, blood pressure 130/80 mm Hg, pathology of internal organs is not revealed. Notes smoothness of the lumbar lordosis and right-sided scoliosis. Palpation is determined by the tenderness of the spinous processes of L4and L5vertebral and paravertebral points at these levels. Upright noticeable tension of the back muscles, especially on the right. In the horizontal position, the back muscles are not tensed, on the contrary, the tone of their somewhat reduced. Hyporeflexia right Achilles reflex, the symptom Lasaga right 35%, reduced surface skin sensitivity in the L5 dermatome on the right. On survey radiographs of the spine are determined by reducing the height of the disk between the L4and L5vertebrae to 11 mm, the functional radiographs dynamic instability of the vertebral motor segment of the L4-5Stage II. When magnetic resonance tomographic study to identify who and posterolateral hernia L 4disk size 6 mm When conducting electroneuromyographic studies - moderate radiculopathy L5on the right, the stage of denervation-irritative disorders.

Clinical diagnosis: osteochondrosis of the L4-5med., III period, posterolateral hernia L4drive to the right, the instability of the L4ELVs radiculopathy L5right moderate severity.

The patient performed decompressive-stabilizing operation of the ventral access with the removal of posterolateral hernia repair and replacement of the disk L4the titanium-polymer functional design (patent RF №2080841). The postoperative period was uneventful. Pain regressed, healing scar primary tension sutures were removed on the 7-eday. According to the electroneuromyographic studies were recorded reduction of symptoms of irritation on the dermatome L5right, that objectively testified about the elimination of disco-radicular conflict and the beginning of the reinnervation process in neurotome L5.

To speed up the recovery functions of the musculoskeletal system through the 7 days after surgery prescribed course of electroneurostimulation of 12 treatments in three stages: 1-3 day; day 4; 5-12 day.

1 day. Electrostimulation symmetric kristnovoselic and gluteal muscles. the sludge current 15-20 mA (tangible, but painless contraction-stimulated muscle), frequency of 70 Hz, the time of sending packets of pulses is 2 seconds, the interval between sent packets - 2 sec, the duration of stimulation is 20 minutes.

- Electrical stimulation of muscles healthy legs: quadriceps and biceps femoris, anterior tibial muscle, triceps tibia. Current 15-20 mA (tangible, but painless contraction-stimulated muscle), frequency of 70 Hz, the time of sending packets of pulses is 4 seconds, the interval between sent packets - 4 sec. Muscles are stimulated alternately, the first flexors, then the extensor, the duration of stimulation is 20 minutes.

- Electrical stimulation of muscles sore legs: quadriceps and biceps femoris, anterior tibial muscle, triceps tibia. Current 15-20 mA (tangible, but painless contraction-stimulated muscle), frequency of 70 Hz, the time of sending packets of pulses is 4 seconds, the interval between sent packets - 4 sec. Muscles are stimulated alternately, the first flexors, then the extensor, the duration of stimulation is 20 minutes.

day 2. Treatment as in 1 day, but the current strength in all three cases, set to 40 mA.

day 3. Treatment as in 1 day, but the current strength in all three cases, set of 50 mA. (until the average force of muscle contractions).

day 4. Alternately subjected to electro is simulatie muscles (symmetric crestronitalia and gluteal) and nerve trunks healthy, and then the patient limb. When electromyostimulation current is 50 mA (tangible, but painless contraction-stimulated muscle), frequency of 70 Hz, the time of sending packets of pulses is 2 seconds, the interval between sent packets - 2 sec, the duration of stimulation - 20 minutes. For electrical stimulation of nerve trunks healthy limb indifferent electrode impose paravertebral lumbar-sacral region, and an active electrode in the popliteal fossa - 5 minutes, then behind the medial malleolus - 5 minutes, then on the rear foot - 5 minutes. The pulse current of 15-20 mA rectangular shape with a smoothly varying frequency from 20 Hz to 120 Hz, with a period of 4 seconds. When the electrical stimulation of nerve trunks patient lower limb indifferent electrode impose paravertebral lumbar region, an active electrode in the popliteal fossa - 5 minutes, then behind the medial malleolus - 5 minutes, then on the rear foot - 5 minutes. The pulse current of 15-20 mA rectangular shape with a smoothly varying frequency from 20 Hz to 120 Hz, with a period of 4 sec.

day 5. The treatment regimen as in 3 day.

day 6. The treatment regimen as in 4 day.

7 day. The treatment regimen as in 3 day.

day 8. The treatment regimen as in 4 day.

day 9. The treatment regimen as in 3 day.

10 day. The treatment regimen as in 4 day.

11 day. The treatment regimen as in 3 day.

12 day. The schema Le is to be placed as day 4.

After 12 treatment sessions the patient was discharged home in good condition, complaints actively does not show. The follow-up 1 year after surgery: exacerbations and relapses no, numbness and a feeling of "coldness" in the lower limbs went through 3 months after discharge from the hospital, doing his usual work.

Thus, the proposed method of electroneurostimulation in patients with osteochondrosis of the lumbar motor segments with instability and disco-radicular conflict after decompressive-stabilizing operations with implantation of an artificial prosthetic intervertebral disc allows you to quickly restore the function of the musculoskeletal system in the early postoperative period, which significantly reduces the recovery period patients up to 6 months.

1. The way multi-channel electroneurostimulation in patients with lumbar osteochondrosis after implantation of the intervertebral discs, includes separate electrical stimulation of nerves and muscles, characterized in that conduct phased electrical stimulation pulses of rectangular shape of the muscles of the trunk and lower extremities sequentially in three zones: the first zone is symmetric Sacro-spinous and glutes, the second zone - the muscles of the healthy limb, the third zone - the muscles of the patient limb and, alternating electric stimulation of the peroneal and tibial nerves, when stimulated muscles of the lower extremities are the quadriceps and biceps femoris, anterior tibial muscle and triceps tibia.

2. The method according to claim 1, characterized in that at the first stage, the stimulation of only the muscles of the body and lower limbs.

3. The method according to claim 1, characterized in that in the second stage stimulation symmetric Sacro-spinous and gluteal muscles alternate to the stimulation of the peroneal and tibial nerves.

4. The method according to claim 1, characterized in that in the third phase, the stimulation of the body's muscles and lower extremities alternate to the stimulation of the peroneal and tibial nerves.

5. The method according to claim 1, characterized in that the double-sided radicular syndrome second area muscles are less affected limb, the third area - the muscles most affected limb.



 

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