RU2337644C1 - Method of treatment of osteoarthrosis of knee joint complicated by secondary synovitis - Google Patents

Abstract

FIELD: medicine; orthopedy.

SUBSTANCE: perform keyhole sanation of a knee joint. Administer an ozone-oxygen admixture intracapsular 3-4 times with 5 mg/l content of ozone and administer Ketonal lymphotropically in a dose of 100 mg on 200.0 ml of a normal saline solution with the subsequent pneumocompression. Next day administer an ozonised normal saline solution lymphotropically with 2.0 mg/l concentration of ozone with the subsequent pneumocompression. Perform administration of an ozone-oxygen admixture and Ketonal in day.

EFFECT: increase of treatment efficiency; reduction of a dose of nonsteroid antiinflammatory preparations and reduction of quantity of administrations and time spent for it.

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Description

The invention relates to medicine, namely to traumatology and orthopedics, in particular to the treatment of osteoarthritis of the knee joint complicated by secondary synovitis.

The traditional treatment of osteoarthritis of the knee joint complicated by synovitis consists of joint puncture, synovial fluid aspiration, washing of the joint cavity with arthroscopy, intra-articular administration of glucocorticoids, use of non-steroidal anti-inflammatory drugs (NSAIDs) (Yu. A. Olyunin. Chronic synovitis in rheumatology. Assessment of activity and treatment // Russian medical journal. - 2005. - Volume 13, No. 8. - C 548-551).

The disadvantage of this method is the need for joint puncture, which causes additional reactive inflammation of the synovial membrane, the use of glucocorticoids can lead to the development of an infectious complication, exacerbation of synovitis by the type of crystalline arthropathy, an increase in cartilage destruction, up to aseptic necrosis. The use of NSAIDs can also lead to the development of side effects from the gastrointestinal tract, liver, kidneys, etc., while some of them accelerate the destruction of cartilage.

A known method of treating osteoarthrosis of large joints by intra-articular injection of an ozone-oxygen gas mixture (ozone concentration was 5 mg / l) with glucocorticoids. At the same time, intravenous administration of ozonized physiological solution was carried out with an ozone concentration in the solution of 0.85 ± 0.05 mg / l, 200 ml daily. The course of treatment consists of 3-5 intraarticular injections and 10-12 intravenous injections (Grechko V.N., Didenko A.A., Fomina L.A. The use of ozone in the complex treatment of patients with osteoarthritis of large joints. // Ozone in biology and medicine. - N.-Novgorod. - 2003. - S.232-233).

The disadvantage of this method is the need for joint punctures and intra-articular administration of glucocorticoids. The duration of treatment is about 15 days.

The closest taken as a prototype is a method of treating osteoarthrosis of the knee joint complicated by reactive synovitis by stimulating natural lymphatic drainage, consisting in sequential stepwise bandaging of the lower extremity and combined tension of the muscles of the leg and thigh. From the toes of the foot in the proximal direction to the knee joint, the limb is bandaged with an elastic bandage. After 10-15 minutes, without removing the first bandage, bandaging was performed in the proximal direction from the upper third of the leg to the middle third of the thigh. The first bandage was removed, elastic compression lasted 10-15 minutes. These events were held 6-7 times a day. Patients were prescribed NSAIDs in traditional therapeutic dosages (ketonal up to 200 mg per day), amplipulse, exercise therapy, limb massage. The duration of treatment is 7-8 days (Tikhonenkov S.N., Dubrovin G.M., Kovalev P.N., Storozhenko N.V., Mordvinov B.B., Markovich E.A. Treatment of non-infectious synovitis by stimulation of natural drainage of the knee joint. // Man and his health. Collection of scientific papers. - Kursk. - 2000. S.112-114).

However, this method requires a significant amount of procedures (on average 6-7 per day, it takes about 3 hours in time), the moment of bandaging causes inconvenience to the patient, especially in the first days of treatment, when the joint function is impaired, which requires outside help , but this is not always possible. This method does not allow affecting other pathogenetic factors in the development and progression of osteoarthrosis of the knee joint.

Object of the invention: increasing the effectiveness of treatment of osteoarthritis of the knee joint complicated by secondary synovitis, reducing the dose of non-steroidal anti-inflammatory drugs, reducing the number of procedures and time spent on it.

The problem is solved by the method consisting in the fact that arthroscopic debridement of the knee joint is carried out 3-4 times intracapsularly, every other day, an ozone-oxygen mixture is introduced with an ozone content of 5 mg / l and a lymphotropic non-steroidal anti-inflammatory drug ketonal in a dose of 100 mg per 200.0 ml of physiological saline followed by pneumocompression with a cycle duration of 30-40 seconds and a session of 30-40 minutes, in the intervals between these procedures, ozonized saline solution is injected lymphotropically with an ozone concentration of 2.0 mg / l, followed by pneumocompression with a cycle duration of 30-40 seconds and a session duration of 30-40 minutes.

In practice, the method is as follows.

Standard arthroscopy is performed, in which the diagnosis is clarified, chondrrectomy, debridement, chondroplasty are performed, and, if necessary, biopsy, articular lavage. Before the operation is completed, under visual control, through the operating trocar openings, two catheters with a diameter of 1 mm are placed intracapsularly in the region of the side walls of the patella bag. The areas of catheter placement are selected taking into account a large number of superficially located (relative to the joint cavity) lymphatic vessels of the synovial membrane of the knee joint. After suturing the trocar wounds, 20 ml of an ozone-oxygen mixture with an ozone concentration of 5 mg / l is injected intracapsularly through each catheter. Lymphotropic administration of 100 mg of ketonal per 200.0 ml of physiological saline is carried out in the chamber. The procedure consists of two stages. The first step is to infuse the solution using a system for dropping through a needle (length 6-8 cm, lumen diameter 1 mm) into the subcutaneous tissue of the anterior outer thigh. The rate of administration is 30-40 drops per minute. The second stage, after the end of the subcutaneous administration of the drug, an eight-section cuff is put on a limb from an automatic Lympha-E type air massager. We carry out pneumatic compression in the “growing wave” mode. The set operation parameters are as follows: cuff pressure 80-100 mm Hg, cycle time 30-40 seconds. The duration of the session is 30-40 minutes. The next day, lymphotropic administration of 200.0 ml of ozonized physiological solution with a concentration of ozone in solution of 2.0 mg / l was carried out, followed by pneumocompression. These injections are carried out every other day, the course of therapy is 5-7 days.

This method of treatment was carried out by 35 patients with osteoarthritis of the knee joint complicated by secondary synovitis. Under the influence of the treatment, a significant improvement in all clinical indicators was obtained. By the end of treatment, the symptoms of reactive synovitis were stopped in 33 patients, the pain syndrome on the visual analogue scale significantly decreased in all patients, the total algo-functional index of Leken decreased, the range of movements in the joint significantly increased. At the same time, all patients noted an improvement in limb support ability.

Example 1. Patient Sh., 53 years old (i.b. 2886), was admitted to the traumatology department of the 5th Air Force Command Center of the Air Force on 05/03/2006 with a diagnosis of osteoarthritis of the first stage, secondary synovitis of the left knee joint. From the anamnesis: pains in the left knee joint worry about 5 years. In October 2005, she suffered an injury to the left knee joint (falling to the knee), after which the pain intensified, periodically, after a long walk, she noted a swelling of the joint area. In March 2006, the pain intensified, was treated on an outpatient basis with a diagnosis of osteoarthritis, synovitis of the left knee joint. Joint punctures, evacuation of excess synovial fluid, intra-articular administration of diprospan, and NSAIDs (diclofenac 150 mg / day) were performed. Due to the lack of effect of the treatment for a month, she turned to 5 Air Force Command Center. On admission, the contours of the left knee joint are smoothed out, the patella runs, pain in the projection of the joint space from the inside. Movement is limited due to pain, flexion in the joint - 90 °, extension - 180 °. It moves with a medical cane with a metered load on the left leg. In clinical blood tests, from significant pathological changes, an increase in ESR up to 25 mm / h is noted. Biochemical blood tests and clinical tests of urine without pathology. Radiological: signs of osteoarthritis of the first stage according to Kellgren and Lawrence. Pain at rest according to YOUR - 10 mm, in motion - 60 mm. Leken Index - 9. 04.05.2006 arthroscopy was performed, congestive hyperemia, hypertrophic club-shaped enlarged sclerosed synovial villi, chondropathy of the patella and the internal condyle of the tibia of the third degree were revealed in the upper patella inversion. Shaving of the damaged cartilage, washing of the joint cavity with physiological saline up to 4 l was performed. Under the control of an arthroscope, catheters for introducing a gaseous ozone-oxygen mixture are installed intracapsularly in the region of the side walls of the patella bag. Further, treatment was carried out according to our method: an ozone-oxygen mixture at a dose of 20 ml was injected intracapsularly into each catheter with an ozone concentration of 5 mg / l, lymphotropic administration of 100 mg of ketonal in 200.0 ml of physiological saline followed by pneumocompression with a cycle time of 30 seconds and the session lasts 30 minutes. The next day, lymphotropic administration of ozonized physiological solution with an ozone concentration of 2 mg / L was carried out, followed by pneumocompression with a cycle time of 30 seconds and a session duration of 30 minutes. The procedures were performed every other day. Passive movements in the joint started on the second day after surgery, active on the third day. The patient moved without support on her left leg with crutches for three days, then one week later with a medical cane. Immobilization was not applied, the knee joint was fixed with an elastic knee pad. Pain at rest was stopped after 1 day of treatment, accumulation of excess synovial fluid stopped after 3 days, pain when walking was significantly stopped after 5 days from the start of lymphotropic therapy. Lymphotropic administration of drugs was discontinued on the 5th day from the start of treatment. Discharged after a week in satisfactory condition. When discharge ESR 17 mm / h, pain at rest according to YOUR - 0 mm, in motion - 20 mm. Leken index - 5, movement in the joint: flexion - 60 °, extension - 180 °. When examined after three and six months, there is no effusion in the joint, the range of motion is full, it moves without limping with a full load on the left leg.

Example 2. Patient Z., 46 years old (ib. 4249), was admitted to the traumatology department of the 5th Air Force Command Center of the Air Force on 08.07.2006 with a diagnosis of osteoarthritis of the second stage, secondary synovitis of the left knee joint. From the anamnesis: in April 2006 arthroscopy was performed, along which damage to the medial meniscus, chronic synovitis, and chondropathy of the medial condyle of the tibia of stage IV were revealed. Performed partial meniscectomy, chondroplasty, joint lavage. Discharged on the 10th day after surgery with a marked improvement for outpatient treatment. A month after discharge, in connection with a violation of the motor regime, an exacerbation of chronic synovitis occurred. It was treated as an outpatient at the place of residence, joint punctures, aspiration of excess synovial fluid were performed, Kenalog-40 of 1 ml was injected three times into the joint cavity, ketonal tablets up to 300 mg / day, limb immobilization. Due to the lack of effect of the treatment for 1.5 months, he turned to 5 Air Force Command Center. On admission, the contours of the left knee joint are smoothed out, the patella runs, sharp pain in the projection of the joint space from the inside and outside. Movement is sharply limited due to pain, flexion in the joint - 140 °, extension - 170 °. Moved with crutches without loading the left leg. In clinical blood tests, from significant pathological changes, an increase in ESR to 54 mm / h is noted. Biochemical blood tests and clinical tests of urine without pathology. Radiological: signs of osteoarthritis of the second stage according to Kellgren and Lawrence. Pain at rest according to YOUR - 40 mm, in motion - 85 mm. Leken Index -> 12. 07/11/2006 arthroscopy was performed, hypertrophy of the synovial membrane with end sclerosis was revealed, the most pronounced in the patellar inversion and medial lateral canal, many adhesions, no increase in the area of chonropathy was noted. Dissection of adhesions, washing of the joint cavity with physiological saline up to 4 l. Under the control of an arthroscope, catheters for introducing a gaseous ozone-oxygen mixture are installed intracapsularly in the region of the side walls of the patella bag. Subsequently, treatment was carried out according to our method: an ozone-oxygen mixture at a dose of 20 ml was injected intracapsularly into each catheter with an ozone concentration of 5 mg / l, lymphotropic administration of 100 mg of ketonal in 200.0 ml of physiological saline followed by pneumocompression with a cycle time of 40 seconds and session lasting 40 minutes. The next day, lymphotropic administration of ozonized physiological solution with an ozone concentration of 2 mg / L was carried out, followed by pneumocompression with a cycle time of 40 seconds and a session duration of 40 minutes. The procedures were performed every other day. Passive movements in the joint started on the second day after surgery, active on the third day. The patient moved without support on his left leg with crutches for a week, then for a week with a medical cane. Immobilization was not applied, the knee joint was fixed with an elastic knee pad. Pain at rest was stopped after a day of treatment, the accumulation of excess synovial fluid stopped after four days, pain when walking was significantly stopped after 7 days from the start of lymphotropic therapy. Lymphotropic administration of drugs was stopped on the 7th day from the start of treatment. Discharged after two weeks in satisfactory condition. When discharge ESR 22 mm / h, pain at rest according to YOUR - 0 mm, in motion - 35 mm. Leken index - 7, movements in the joint: flexion - 90 °, extension - 180 °. When examined after three and six months, there is no effusion in the joint, the range of motion is full, it moves without limping with a full load on the left leg.

Thus, the proposed method of treatment allows to increase the efficiency of treatment of patients with osteoarthritis of the knee joints complicated by secondary synovitis, to reduce the dose of non-steroidal anti-inflammatory drugs by 2-3 times, to reduce the number of administrations (up to 1 per day) and the time spent on it (up to 1 hour per day )

Claims (1)

A method for the treatment of osteoarthrosis of the knee joint complicated by secondary synovitis, including the introduction of ketonal, characterized in that the arthroscopic sanitation of the knee joint is performed, an ozone-oxygen mixture containing ozone 5 mg / l and lymphotropic ketone in a dose of 100 mg per 200.0 are administered 3-4 times intracapsularly ml of physiological saline followed by pneumocompression, the next day, ozonized physiological saline with an ozone concentration of 2.0 mg / l, followed by pneumocompression, is injected lymphotropically, with the introduction of ozone-oxygen bottom mixture and ketonal carried out every other day.