Method of treating chronic hematogenous osteomyelitis in children

FIELD: medicine.

SUBSTANCE: invention relates to physiotherapy. Method includes contact impact on lesion focus. Impact is performed with extremely high-frequency electromagnetic field. Preliminary impact is performed on the area of lymph nodes in inguinal region. Impact is performed with wavelength 5.6 mm, frequency 53.5 GHz, intensity 10 mW/cm2. Impact lasts 20 minutes. After that, impact is performed on lesion focus. Impact is performed with wavelength 7.1 mm, frequency 42.2 GHz, intensity 10 mW/cm2. Impact lasts 20 minutes. Procedures are performed daily. Course of treatment includes 10 procedures.

EFFECT: method can be used in treatment of children of any age, in presence of metal constructions, wet bandages.

2 ex

 

The invention relates to physical therapy and pediatric surgery, and is intended for the treatment of children with chronic osteomyelitis, including in the postoperative period.

Chronic osteomyelitis occurs as a consequence of acute hematogenous osteomyelitis. A characteristic sign of chronic osteomyelitis are scars or flaws, which when remission is closed or some small serous-purulent discharge. Often the emergence and existence of a constant purulent leads to the development of degenerative changes in the muscular system of the limbs and internal organs. Radiographically chronic hematogenous osteomyelitis is characterized by increasing proliferative references for additional information process and formed abnormal bone structure. The porosity of the bone decreases and is replaced by osteosclerosis with the presence of a sequestrum.

Surgical treatment of this pathology in the presence of fistula is the primary method of treatment, as well as widely used physiotherapeutic methods for the prevention of complications such as deformity and growth disorders of the limbs, pathological fractures, false joints and various bone defects, etc.

Physiotherapy for chronic osteomyelitis is aimed at preventing the escalation process, the stimulation of blood circulation and infoteca in bone and surrounding tissues, stimulation of General and local immunity.

Known methods of physiotherapeutic treatment of chronic hematogenous osteomyelitis using UHF microwave therapy (frequency of 460 MHz, the wave length 65 cm) and centimeter microwave therapy (frequency of 2450 MHz, the wavelength of 12.2 cm). Assigned to these methods on the projection of the lesion in bone, labetalol dosage. The procedure duration is 15 minutes, the course of treatment up to 15 procedures. (Milbrath I.M. and other Physical factors in the treatment and rehabilitation of trauma and surgical patients. /Balneology and physiotherapy / edited Vmmolotova. - M, Medicine. - 1985. - Vol.2. - str.)

However, the use of this method is limited.

For example, this method cannot be used in patients with superimposed ointment and wet dressings, in the presence of metal structures. Additionally, if the method is not excluded aggravation, especially when fistulous form, due to the deep penetration factor and heat.

There is a method of treatment of chronic hematogenous osteomyelitis in children, including contact effects on lesion high-frequency electromagnetic field. (Milbrath I.M. and other Physical factors in the treatment and rehabilitation of trauma, orthopedic and chirurgiche the fir sick. /Balneology and physiotherapy / edited Vmmolotova. - M, Medicine. - 1985. - Vol.2. - str).

This method uses a frequency of 13.5 kHz in labetalol dosage, at the location of the inductor on the projection of inflammation. The procedure lasts 15 minutes, the treatment course is 10 sessions.

The disadvantage of this method is the risk of exacerbation of the inflammatory process in purulent discharge from the fistula, the inability to apply under hypotonic conditions, the presence of metal structures and moist dressing. There are contraindications for treatment of children under the age of 5 years.

To eliminate the described disadvantages of the authors of the task, aimed at creating a method with greater functionality, by providing local anti-inflammatory action, improve blood circulation in inflammation, stimulate the immune system, reduction processes in the bone tissue. Additionally, the method has no limitations on age and condition of the wound, presence of metal structures.

To solve this problem in the treatment of chronic hematogenous osteomyelitis in children, including contact effects on lesion high-frequency electromagnetic field, the proposed impact to make extremely high-frequency electromagnetic p. the LEM, and previously to affect the area of the lymph nodes in the groin area, a wavelength of 5.6 mm, a frequency of 53.5 GHz, the intensity of 10 mW/cm2within 20 minutes, and then to the lesion a wavelength of 7.1 mm, frequency, 42,2, GHz, an intensity of 10 mW/cm2within 20 minutes. The course of treatment is 10 daily procedures.

The effects of extremely high frequency therapy of electromagnetic radiation of millimeter range - UHF (5.6 mm, 53,5 GHz; 7,1 mm to 42.2 GHz) due to the small wavelength is well absorbed by water molecules, hydrated proteins and collagen fibers and has low penetrating power into the skin of 0.2-0.6 mm, the energy flux density does not exceed 10 mW/cm2. According to the literature, therapeutic effect of EHF-therapy is associated with the management of restorative processes and mobilising the reserve capacity of the body. EHF exposure stimulates the body's nonspecific adaptive resistance, while mobilized protective (immune status) and regulatory (neurohumoral factor) function, change the physico-chemical properties and lipid composition of biological membranes. In the treatment of EHF-therapy improves circulation in inflammation. How has anti-inflammatory, analgesic action, stimulare the regeneration processes the immune system, helps to prevent exacerbation of the process. The procedure does not cause discomfort in the patient, does not have a thermal effect and may be used as in remission, and in the acute stage, combined with medical and surgical methods of treatment in any stage of the inflammatory process. The effect on the lymph nodes in the groin area helps stimulate the immune system. Lymph nodes after the skin and mucous membranes are the second barrier to infection, attacking the body. Tissues drained by the lymphatic vessels through which lymph flows in the marginal sinus through the cells of the cortical substance to macrophages and sinuses of the brain substance, then efferent vessels of the lymph enters the thoracic duct and thence into the blood. During the formation of the immune response of T-lymphocytes in the lymph node into lymphoblasts and actively proliferate, stimulating immune processes.

The implementation of the method of treatment is illustrated with specific examples.

Example 1

Patient K., born in 1996, was in the Department of pediatric surgery MONICA with 09.06.2011, with a diagnosis of chronic osteomyelitis of the right humerus.

Hospitalized in the direction of the regional medical institution, upon receipt complains of pain in the shoulder area, the less movements in the shoulder joint slight swelling of the shoulder, low-grade fever. In the clinical analysis of peripheral blood leukocytes of 18.2109, ESR - 20 mm/hour, increase platelet stab of white blood cells, decrease in the number of lymphocytes, decreased total protein, increased CRP to 5 mg/L. Protein fractions: total protein - 72 g/l, albumin - 55%. Globulins - alpha 1 - 3%, alpha 2 - 8%. Beta 11%, gamma - 23%, the index A/G=0,8. Upon receipt marked by high concentrations of calcium and phosphorus, because phosphorus-calcium bone demineralization during the course of the disease.

X-rays of the right humerus bone-destructive changes showed no marked periosteal reaction.

Conducted comprehensive treatment, including medication and physical therapy on the proposed method: EHF-therapy initially performed on the lymph nodes of inguinal region, and the wavelength was 5.6 mm, the frequency of 53.5 GHz, the intensity of 10 mW/cm2, worked for 20 minutes, then UHF on the projection area of inflammation in the bone, a wavelength of 7.1 mm, frequency, 42,2, GTZ, the intensity of 10 mW/cm2within 20 minutes. The course of treatment 10 daily procedures.

As a result of treatment there is a strong positive trend: significantly decreased pain, was swelling, increased range of motion in the joint. In clinically the ish analysis of peripheral blood leukocytes of 11.210 9, ESR - 6 mm/h, total protein, 76 g/l, albumin 42,55%. The observed dynamics to the reduction in serum IgM and IgA, increased phagocytosis indices nst and the latex test. Increased 3% CEC before treatment tends to decrease.

Example 2. Patient G., 1999, p., diagnosed with post-traumatic osteomyelitis W metatarsal of the right foot.

Aimed at the treatment of the regional clinic. When entering the fistula with purulent discharge in the area of the arch of the foot, minor pain, swelling, low grade fever, limitation of motion in the foot.

In the clinical analysis of blood L=6,6109ESR - 15 mm/hour, urine analysis no abnormalities in the biochemical analysis of blood a slight increased Alp and SR protein.

On retinogram the presence of fistulous course and periosteal reaction.

Conducted comprehensive treatment, including medication and physical therapy on the proposed method: EHF-therapy initially performed on the lymph nodes of inguinal region, and the wavelength was 5.6 mm, the frequency of 53.5 GTZ, the intensity of 10 mW/cm2, worked for 20 minutes, then UHF on the projection area of inflammation in the bone, the wavelength of 7.1 mm, frequency 42,2, GHz, intensity of 10 mW/cm2within 20 minutes. The course of treatment 10 daily procedures.

After conducting the spent treatment showed reductions in discharge from the fistula, it acquired the character of ichor, the absence of pain, swelling, increase range of motion in the foot. In the clinical analysis of peripheral blood L=5,6109, ESR - 9 mm/hour, a normalization index of Alp and CRP in the biochemical analysis of blood, pronounced positive dynamics of immunity (IgA, IgM, IgG, CEC, nst and latex-test). On retinogram the presence of fistulous course, minor periosteal reaction.

The efficiency of the method

Using this method were treated with 8 people with a positive effect. The advantage of this method is simplicity vacation procedures, the use of domestic portable equipment, allowing to carry out the treatment in the chamber based on the severity of the pathology, practical absence of contraindications.

A method of treating chronic hematogenous osteomyelitis in children, including contact effects on lesion electromagnetic field, characterized in that the influence exercised by the extremely high frequency electromagnetic field, and pre-impact on the area of the lymph nodes in the groin area, a wavelength of 5.6 mm, a frequency of 53.5 GHz, the intensity of 10 mW/cm2within 20 min, and then to the lesion, a wavelength of 7.1 mm, frequency, 42,2, GHz, an intensity of 10 mW/cm2, who for 20 min, the course of treatment is 10 daily procedures.



 

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