RU2380078C1 - Method for prevention of complications in knee joint replacement - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, namely - surgery. The method involves physiotherapeutic treatment preceding knee joint replacement. It implies mechanical pneumatic compression of lower limbs in combination with the electrostimulation device "Lymphavision". The electrostimulation involves application of the electrodes on the anteromedial surface of the lower one-third of shin and on the medial surface of the upper one-third of hip. The course includes 7 sessions. The operation is followed with limb elevation within 7 days and physiotherapeutic treatment. Herewith, knee joint region is galvanised. The electrodes are applied transversely, with medial and lateral surfaces from patella. The sessions are performed daily.

EFFECT: method improves clinical effectiveness ensured by rapid reduction of hemarthrosis and improvements of lymphatic and venous outflow within knee joint.

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Description

The invention relates to medicine, namely to surgery. It can be used for knee arthroplasty.

The present method has no analogues; it is distinguished by simplicity of execution, affordability, efficiency and low cost.

The method consists in the fact that before endoprosthetics of the knee joint, patients undergo a course of physiotherapeutic treatment using mechanical pneumocompression of the lower extremities, in combination with electrical stimulation on the apparatus "Lymphavigin", during which the electrodes are applied on the front-medial surface of the lower third of the leg and on the medial surface of the upper thirds of the thigh, the course consists of 7 sessions. In the ward after surgery, the operated lower limb is placed on the Belera splint, the lower limb is elevated within 7 days after the operation, physiotherapy treatment begins with galvanization (direct current electrotherapy) from the first day after the operation, the electrodes are applied transversely, with the medial and lateral surface from the patella. During the treatment, 7 sessions of physiotherapy treatment are carried out daily.

The technical result consists in the rapid relief of hemarthrosis and pain in the postoperative period, an increase in the speed and volume of lymphatic outflow, an improvement in blood flow - an increase in the speed and volume of venous outflow both in the region of the entire lower limb and in the knee joint in particular.

In order to evaluate the effectiveness of the proposed treatment, a comparative analysis of case histories of 36 patients who underwent knee replacement was performed.

Patients were randomly divided into two groups, the patient of the first group (17 patients) underwent knee replacement with standard management of the perioperative period, the patients of the second group (19 patients) underwent knee replacement by the proposed method against the background of standard therapy . Evaluation of the effectiveness of the proposed treatment was carried out by assessing hemarthrosis (the number of punctures of the knee joint and the location of the drainage), assessing the severity of pain, a comparative analysis of reolymphazography, radionuclide lymphoscintigraphy. As a result, it was proved that the proposed method of treatment, including a preoperative course of physiotherapeutic treatment (mechanical pneumocompression of the lower extremities and electrical stimulation on the apparatus "Limfavizhin"), postoperative elevation of the lower limb and postoperative physiotherapeutic treatment (electrotherapy with direct current) on the knee joint area leads to rapid relief hemarthrosis, pain, swelling of the lower limb, an increase in speed and volumetric parameters of the lymphatic and venous outflow.

In 14 patients (73.68%) of the group of the proposed treatment, 1 puncture of the knee joint was required in the postoperative period, in 4 patients (21.06%), 2 puncture of the knee joint was required, and in 1 patient (5.26%) 3 puncture of the knee joint. In 9 patients (52.94%) of the standard treatment group, 4 puncture of the knee joint was required in the postoperative period, in 5 patients (29.42%), 5 puncture of the knee joint was required, in 2 patients (11.76%) 3 puncture of the knee joint, 1 patient (5.88%) required 6 puncture of the knee joint. According to reolymphovasography, an increase in the rate of lymphatic outflow was revealed by 6.78 times more, an increase in the volume of lymphatic outflow by 4.88 times more, an increase in the speed of venous outflow by 15.59 times more, an increase in the volume of venous outflow by 8.76 times, according to radionuclide lymphoscintigraphy, the decrease in the number of radiopharmaceutical at the injection site is 2.3 times less, the increase in the number of radiopharmaceutical in the region of inguinal lymph nodes is 1.33 times more, when determining the severity of pain by visa flax-analog pain scale was found a reduction in pain level of 2.1 times after the proposed treatment than after standard treatment.

The dynamics of the rate of lymphatic outflow, Ohm / s, M ± m Study period OL (n = 17) OL + PL (n = 19) Before treatment 0.24 ± 0.02 0.23 ± 0.02 After treatment 0.22 ± 0.02 0.36 ± 0.04 • Note: • - differences in indicators before and after treatment are significant, p <0.05 Dynamics of indicators of the volume of lymphatic outflow, Ohm, M ± m Study period OL (n = 17) OL + PL (n = 19) Before treatment 0.23 ± 0.02 0.22 ± 0.02 After treatment 0.20 ± 0.02 0.36 ± 0.04 • Note: • - differences in indicators before and after treatment are significant, p <0.05 The dynamics of the venous outflow velocity, Ohm / s, M ± m Study period OL (n = 17) OL + PL (n = 19) Before treatment 0.27 ± 0.03 0.26 ± 0.03 After treatment 0.26 ± 0.03 0.41 ± 0.04 • Note: • - differences in indicators before and after treatment are significant, p <0.05

Dynamics of indicators of the volume of venous outflow, Ohm, M ± m Study period OL (n = 17) OL + PL (n = 19) Before treatment 0.33 ± 0.04 0.32 ± 0.04 After treatment 0.31 ± 0.04 0.49 ± 0.04 • Note: • - differences in indicators before and after treatment are significant, p <0.05 Dynamics of indicators of radionuclide lymphoscintigraphy,%, M ± m Indicator Study period OL (n = 17) OL + PL (n = 19) The amount of radiopharmaceutical at the injection site Before treatment 46.18 ± 2.76 47.49 ± 2.87 After treatment 49.53 ± 3.08 40.57 ± 2.52 • The amount of radiopharmaceutical in the area of inguinal lymph nodes Before treatment 11.68 ± 1.13 10.89 ± 1.03 After treatment 9.25 ± 1.06 13.91 • Note: • - differences in indicators before and after treatment are significant, p <0.05 The dynamics of the severity of pain according to the visual-analogue scale, mm, M ± m Study period OL (n = 17) OL + PL (n = 19) Before treatment 56.3 ± 4.2 58.18 ± 4.4 After treatment 43.1 ± 3.7 22.83 ± 2.9 • Note: • - differences in indicators before and after treatment are significant, p <0.05

Clinical example.

Patient G., 56 years old. Diagnosis: Deforming osteoarthrosis. Post-traumatic gonarthrosis on the right 3 tbsp. Gonalgia.

Eight years ago, after an injury to the right knee joint, an arthrotomy, meniscectomy was performed, 3 years ago I noted pain, a crunch in the right knee joint, and walked with a cane over the past year. Examination - general clinical, reolymphovasography of the lower extremities, radionuclide lymphoscintigraphy, determination of the level of pain on a visual-analogue scale. In treatment - a course of physiotherapeutic treatment using mechanical pneumocompression of the lower extremities, in combination with electrical stimulation on the Limfavizhin apparatus (7 sessions each), endoprosthetics of the right knee joint, after the operation, the operated lower limb was placed on the Belera splint, elevation of the right lower limb within 7 days after the operation, from the first day after the operation, physiotherapeutic treatment was carried out by galvanization (direct current electrotherapy) on the knee joint but. In the postoperative period, 1 puncture of the knee joint was required. According to the reolymphasovographic study, the following dynamics of the indicators was revealed: the rate of lymphatic outflow is 0.34 Ohm / sec, the volume of lymphatic outflow is 0.35 Ohm, the speed of the venous outflow is 0.39 Ohm / sec, the volume of the venous outflow is 0.46 Ohm, According to radionuclide lymphoscintigraphy, the amount of the radiopharmaceutical at the injection site is 42.86%, the amount of the radiopharmaceutical in the region of the inguinal lymph nodes is 11.49%, the level of pain on the visual-analogue scale is 25 mm.

When applying the presented method, effective early relief of hemarthrosis, pain, swelling of the operated lower limb is carried out, there is an improvement in venous and lymphatic drainage both in the region of the knee joint and in the region of the entire lower limb.

Claims (1)

A method for the prevention of complications in knee arthroplasty, characterized in that prior to knee arthroplasty, patients undergo a physiotherapeutic treatment using mechanical pneumocompression of the lower extremities, in combination with electrical stimulation on the apparatus “Limfavizhin”, during which the electrodes are applied over the front-medial surface of the lower third tibia and on the medial surface of the upper third of the thigh, spend 7 sessions, after surgery for 7 days carry out an elevation of impurities and physiotherapeutic treatment by galvanization on the area of the knee joint, while the electrodes are applied transversely from the medial and lateral surfaces from the patella, sessions are carried out daily.