RU2134088C1 - Method for treating patients possessing acute subcutaneous muscle injuries - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying plaster immobilization. Neaton (phosphocreatine) is administered as 5 intramuscular injections course into traumatized muscle ends at a dose of 1000 mg/day. Intravenous injections are administered each second day at a dose of 3000 mg/day as 5 injections long course. Plaster immobilization is interrupted in 6 days. Active movements in adjacent joints are carried out during 4 days. The movements are done within the pain feeling limits three times a day during 10-15 min. Movements are to be slow. EFFECT: enhanced effectiveness of treatment; complete recovery of injured region.

Description

 The method relates to the field of medicine, namely to traumatology, and is intended to create favorable conditions for damaged skeletal muscle, contributing to the regeneration of muscle fibers, improving their orientation and ultimately healing the damaged area with full muscle regeneration.

 It is known that as a result of muscle damage, muscle fibers and the connective tissue cases surrounding them, as well as intramuscular nerve trunks and blood vessels, are partially or completely torn, and after a reduction in the parts of the muscle, a gap appears between the stumps. The latter is filled with a hematoma and later with a proliferating granulation tissue, through which muscle fibers begin to sprout. The growth of connective tissue is ahead of the rate of germination of muscle fibers. Thus, a scar is formed in the area of damage, which negatively affects the functionality of the muscle / V. Craci. P. Koch. Muscle and Tendon Injuries in Athletes. Stuttgart. - 1979; M.U.K. Lehto, M. J. Jarvinen. Muscle injuries, their healing process and treatment. Annales Chirurgiae at Gynaecologiae. - 1991. - Vol. 80. N 2. - S. 102-108 /.

 The leading treatment for acute subcutaneous muscle damage is conservative. Immediately after muscle damage, most authors recommend performing gypsum immobilization for several weeks / I.A. Badnin. Safety and health of ballet dancers. M., 1987 .-- S. 65, 117 /; V. Krejci and P. Koch, 1979, see above; M.U.K. Lehto, M.J. Jarvinen, 1991, see above /, and then, after removing the plaster cast, conduct a course of rehabilitation treatment. Simultaneously with immobilization, novocaine blockades are repeatedly used, which block the pain reflex, improve local blood circulation, reduce the spasm of muscle fibers and thereby accelerate the process of their fusion / I.A. Badnin, 1987, see above; V. Krejci, P. Koch, 1979, see above.

 Based on personal experience and literature data on the method of treatment described above, some of its shortcomings should be pointed out. So, immobilization for several weeks causes muscle atrophy, as a result of which its strength capabilities and elasticity are reduced. Restorative treatment requires a few more weeks. In addition, regenerating muscle fibers are located parallel to the intact /M.U.K. Lehto, M.J. Jarvinen 1991, see above /, which reduces muscle strength and functionality. The use of novocaine blocks relieves pain well, and the symptoms of damage quickly disappear, but the structural restoration of the tissue occurs much later, and as a result there is a danger of an early return to stress and repeated damage.

 In order to accelerate the process of muscle tissue regeneration and minimize the formation of fibrous scar, we used phosphocreatine / neoton /, which is widely used in cardiology practice for ischemic and hypoxic conditions of the heart muscle to reduce the size of the infarction zone and improve the contractile function of the heart. Phosphocreatine under physiological conditions is the end product of mitochondral processes of energy production / Saks V. A. Phosphocreatine pathway of intracellular energy transport: current state of research. In the book: Phosphocreatine: biochemical and pharmacological action and clinical use. M., Science, 1989 .-- S. 11-19 /. In a healthy organism, the content of total creatine / creatine + phosphocreatine / is highest in skeletal muscle, heart and brain tissue. With the introduction of exogenous phosphocreatine, it also accumulates more in these tissues / Khuchua Z.A., Kryzhanovsky S.A., Kacharava V.G. et al. Pharmacokinetics of exogenous phosphocreatine. In the book: Phosphocreatine: biochemical and pharmacological action and clinical use. M., 1989 .-- S. 262-269 /. Thus, exogenous phosphocreatine can serve as a source of energy necessary for the process of muscle regeneration under conditions of slowdown, oxidative metabolic processes.

 Another factor contributing to the regeneration of muscle fibers is the creation of tension in the muscle, which occurs during the exercise of motor function / A.N. Studitsky. Experimental muscle surgery. - 1959. - S. 278. /. The restoration of muscle tissue occurs along the lines directed between the points of attachment of the muscle. M.U.K. Lehto. M.J. Jarvinen / 1991, see above / in their experiments found that after muscle damage for 5 days, immobilization is necessary. During this time, the resulting granulation tissue completely covers the area of muscle damage and gains strength sufficient to stretch it during exercises in therapeutic gymnastics. And this creates directions for the tensile forces that guide the regeneration of muscle fiber.

 The method is as follows.

 For the treatment of patients with these injuries, we use the drug "neoton" / phosphocreatine /, manufactured by the Italian company ALFA SCIAPARELLI WASSERMAN. In this case, we use the dosage developed in cardiopractic for metabolic myocardial disorders: 1000 mg / day intramuscularly and 3000 mg / day intravenously every other day for only 5 procedures. Upon admission to the patient we impose a plaster cast. Immobilization is carried out within 5 days after damage. By palpation, we determine the area of greatest pain in the damaged muscle and inject the drug solution proximally and distally from it at the border with the painless area. After this, a drip infusion of a solution of "neoton" into the ulnar vein is performed. On the sixth day after the injury, remove the plaster cast and assign active movements within the pain in nearby joints 3 times a day for 10 to 15 minutes at a slow pace, course 4 days. After the relief of acute events, which usually occurs on the 10th day after the injury, we prescribe rehabilitation treatment in the gym.

 When comparing two groups of patients with approximately the same type of acute subcutaneous muscle damage, the first / 20 patients / of which were treated with the proposed method, and the second / 30 / with novocaine blockade and gypsum immobilization, we noted that in the first group it was already 3-4 days of treatment soreness in the area of damage is significantly reduced, while in the second - by 6-7. Sports disability in the compared groups was restored in our group of patients after 4 weeks, in the control group / with novocaine / after 6 weeks. When conducting an ultrasound study, it was found that the normalization of the muscle structure of patients treated with the proposed method, occurred on average after 5 weeks, and during treatment according to the prototype - after 7 weeks.

 Thus, the statistically compared groups of patients showed the feasibility of the therapeutic method, its significant difference from the prototype and the use of the previously used therapeutic drug / neoton / for the new purpose.

Claims (1)

 A method of treating patients with acute subcutaneous muscle damage, including gypsum immobilization and subsequent physiotherapy exercises, is characterized in that neoton (phosphocreatine) is administered at a dose of 1000 mg / day, a course of 5 injections every other day and 3000 mg / day intravenously every other day, a course of 5 injections, gypsum immobilization is stopped after 6 days and active movements in nearby joints are prescribed for 4 days within the pain range 3 times a day for 10-15 minutes at a slow pace.