Method of treating temporomandibular joint arthrosis

FIELD: medicine.

SUBSTANCE: invention refers to medicine, specifically dentistry and concerns treating temporomandibular joint arthrosis. For this purpose, mesenchymal cord and placental stem cells received after easy delivery. The cells 5-10·106 are injected in the temporomandibular joint in 1-2 ml of patient's blood plasma and intra-articular fluid. taken from a patient's healthy major joint.

EFFECT: while being low-traumatic, the method provides replacement of articular cartilage defects, creating the environments for optimising the repair processes in treating the most severe and frequent temporomandibular joint injures.

2 ex

 

The invention relates to medicine, namely to stomatologie, and concerns of conservative methods of treatment of arthrosis of the temporomandibular joint.

Deforming arthrosis of the temporomandibular joint is one of the most severe forms of joint pathology and is characterized by the development of destructive changes in the cartilage and bone of the lower jaw head. And only rarely defeat is total character and refers more often to the limited availability of bone protrusions or, on the contrary, the recesses. Conservative treatment at this stage of the disease, as a rule, success has not, and therefore clinicians are forced to resort to surgery.

There is a method of exposure percutaneous electroneurostimulation on the projection of the temporomandibular joint (TMJ) pain syndrome osteoarthritis (problems of neurosonology and dentistry, 1998, 2, pp. 53-54), which use impact on the field of TMJ skin and ear canal, the method of treating pain dysfunction and Valpolicella-degenerative diseases of the TMJ, including electrical stimulation pulse modulated current in the region of the TMJ, masticatory muscles, muscles of the neck (Pat of the Russian Federation No. 2197293).

The disadvantage of these methods is exposed only in the area of TMJ without regard to the muscular component of pain and lack of obezbolivauschaya percutaneous electrical nerve stimulation, that requires procedures several times a day.

Known 3 main methods of surgical treatment of deforming arthrosis: destruction of the articular disk, removing the head of the mandible, removal of the head of the mandible with the subsequent substitution of the resulting defect graft (U.S. Pat. Of the Russian Federation No. 2157114, 1296123, 1801369). However, these methods differ in significant trauma, lead to the final destruction still remained the most important anatomical structures of the joint.

Currently, in clinical practice the treatment of defects of the articular surfaces is carried out only by the replacement of cartilage allografts or autotransplantation.

The problem of choosing a method of treatment of arthritis TMJ conservative ways remains unresolved up to the present time. Usually the success of the treatment is noticeable depending on the duration of remission of the disease, the degree of functional activity of the joint in remission, as well as how the patient is free in remission from drug loads.

However, against the background of various lengths improve the clinical condition of the patient (from 1 month to two years) in the joint continues pathological changes, as may occur after treatment, the remission is always accompanied by drug therapy, for example the non-steroidal protivovospalitel is ranked on drugs also, as you know, are the cause of General and local complications.

There is a method of treatment of osteoarthritis of joints by intra-articular injection of various drugs (rumalon, hydrocortisone, arteparon etc), as well as laser therapy and acupuncture /Maarheeze. Degenerative and post-traumatic joint diseases in outpatient practice. M., 1993, p.21/.

However, this method may cause a purulent arthritis, in the process of its application is trauma paraartikulyarnye tissues, subsequently causing various chronic tentatio with the formation of persistent contractures.

All of the mentioned methods of conservative treatment of osteoarthritis aims to restore hyaline cartilage.

Currently has the ability to restore hyaline cartilage articular surface with a diameter of 5 mm by yourself.

The closest technical solution to the claimed method is a method of treatment of arthrosis of the temporomandibular joint by restoring proper joint due to transplantation of a bone graft (ed. mon. The USSR №1503763). Joint reproduce from hyperplastic area of the jaw cortically plate, taken on soft tissue pedicle, which move from the corner of the jaw in the region cost the main bags. The lack of extension of surgical treatment by taking autograft, and this method allows you to restore anatomicheskuyu the integrity of the joint, but does not allow you to restore the cartilage over the entire area of the joint.

The objective of the invention is to compensate defects of articular cartilage, the obstacle to the development and progression of dystrophic processes in the joints with controlname defects by hyaline cartilage repair these defects, creating the conditions for optimization of reparative processes, reducing trauma during the operation.

This object is achieved through the use of the method of treatment of osteoarthritis of the temporomandibular joint by introducing a graft, which is used as mesenchymal stem cells of the umbilical cord or placenta obtained after a normal birth, with carry introduction cells by injection of 1-2 ml of blood plasma of the patient or synovial fluid taken from healthy large joint of a patient, containing 5-10·106cells in the cavity of the temporomandibular joint.

Mesenchymal stem cells of the umbilical cord or placenta were obtained in accordance with the standard method as follows. Samples of the umbilical cord or the placenta of man collected after normal delivery at 39-40 weeks of gestation. Vienna is rpovini and placenta were Coulibaly and washed first with Hanks solution, and then 0.1% solution of collagenase type I with DMEM without serum, and incubated at 37°C for 30 minutes and Then the vessels were again washed with Hanks solution, the fabric was subjected to a short soft mechanical stress and collecting the separated cells. The obtained cells were besieged by centrifugation. Sediment resuspendable in DMEM containing 10% serum, 100 units/ml penicillin, 100 units/ml streptomycin, 2 mm glutamine, 1 mm sodium pyruvate, 10 ng/ml bazalnogo of fibroblast growth factor (β-FGF), transferred to culture plates and cultured until the formation of the monolayer, changing environment 2 times a week. When reaching the monolayer cells were perseval in the ratio of 1:3.

The method is as follows. Conduct introduction cells by injection of 1-2 ml of blood plasma of the patient or synovial fluid taken from healthy large joint of a patient, such as hip, knee or ankle, containing 5-10·106mesenchymal stem cells of the umbilical cord or placenta obtained after normal childbirth. Depending on the condition of the patient the procedure may be repeated 2-3 times in 1.5-3 months. To enter the cells can, for example, by introducing into the previously selected lymph vessel or by puncture of the joint.

For the treatment of cartilage increases in size, receives sufficient p is food due to diffusion of nutrients from sinoville fluid, that allows the full replacement of the defect with hyaline cartilage.

The invention is illustrated by the following example.

Example 1. Patient A., 67 (East. bol. No. 1749, 2010). He admitted with a diagnosis of osteoarthritis of the TMJ. Complaints of pain in the jaw when eating and talking. The patient made an introduction cells by injection of 1 ml of own blood plasma, containing 5·106mesenchymal stem cells. After 1.5 months had a repeat procedure. After treatment the patient's condition has significantly improved pain completely stopped, resumed full range of motion of the mandible.

Example 2. Patient C. 42 (East bol. No. 452, 2009). He admitted with a diagnosis of osteoarthritis of the TMJ. The patient made an introduction cells by injection of 1 ml of synovial fluid taken from the patient from a healthy hip joint, containing 10·106mesenchymal stem cells. 35 days had a repeat procedure. After treatment the patient pain completely stopped, resumed full range of motion of the mandible.

Similarly, were treated using synovial fluid taken from a healthy knee and ankle of the patient.

Thus, the proposed method allows to solve the problem of biological repair of cartilage in the treatment of nobleeagle and frequent damage to the temporomandibular joint. Joints are created conditions for the formation of cartilaginous cover, improve conditions for maturation of cartilage.

A method of treatment of arthrosis of the temporomandibular joint by introducing a graft, characterized in that as a transplant use of mesenchymal stem cells from umbilical cord or placenta obtained after a normal birth, with carry introduction cells by injection of 1-2 ml of blood plasma of the patient or synovial fluid taken from healthy large joint of a patient, containing 5-10·106cells in the cavity of the temporomandibular joint.



 

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