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Scientific and clinical laboratory of physiotherapy
Chief of the dept.
Irina A. Menshikova |
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Research area
- evaluation of general and local status of orthopaedic and traumatologic patients and discovering optimal ways of their's rehabilitation on stages of treatment by Ilizarov method of transosseous osteosynthesis
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Staff
| Irina A. Menshikova - |
chief of the lab., Doctor of Medicine, physician of the I-st medical category |
| Lidia A. Popova - |
leading research officer, Doctor of Medicine |
| Alexander N. Erokhin - |
leading research officer, physician of the superior medical category, Doctor of Medicine |
| Galina A. Stepanova - |
research assistant, candidate in medical sciences |
| Eduard V. Ershov -
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research assistant, traumatologist-orthopaedist, manual therapeutist |
Methods of treatment
Reflexotherapy
Nowadays reflexotherapy is widely used in complex treatment of different diseases: heart diseases, diseases of lungs, gastrointestinal tract, etc. In RSC RTO reflexotherapy durably entered complex of rehabilitation of orthopaedic and traumatologic patients. Basic indications for prescription of reflexotherapy are: pain syndrome of different segments of locomotor system (backache, pain in joints, neck, etc.), decreasing of functional capability of muscles (caused by neuropathy of peripheral nerves, prolonged decreasing of motion activity, during orthopaedic-traumatologic activities), limitation of motion in joints, caused by contractions of muscle-tendinous genesis. Moreover, a new method of reflexotherapy was developed. It stimulates reparative activity of osseous tissue during limb lengthening and allows to reduce period of treatment. We successfully apply reflexotherapy in cases of disadaptation of patients with severe orthopaedic-traumatologic and neurosurgical pathologies, which are accompanied not only with disturbances of function of internal organs, but also depression, desynchronizing and emotional lability.
Case report
Patient S., age 14, was admitted to RSC RTO with diagnosis: congenital genu varum, shortening of shanks up to 4 cm. After lengthening on 4 cm during 38 days of fixation X-ray examination revealed low-grade, irregular roentgen shadow of regenerated tissue with obvious marginal defect.
Applying of course of reflexotherapy (after 25 days and 15 procedures) induced strengthening of roentgen shadow of regenerated tissue, increased solidity of it's structure in the middle part and activated filling of marginal defect with mineralized osseous tissue.
After next 30 days (93 days of fixation and 30 procedures in total) preservation of structure's homogenicity of formed regenerated tissue and following filling of marginal defect with mineralized osseous tissue were revealed.
Eleven days after Ilizarov apparatus was removed X-ray examination visualized the continual regenerated tissue with some decreasing of roentgenological solidity in the part of former spacious marginal defect.
Interstitial electrostimulation
Method of interstitial electrostimulation was developed and applied into wide clinical practice by prof. A.A. Gerasimov.
Basic mechanisms of medicinal effect of interstitial electrostimulation are:
- general-reflex, which consists in effects on centers of cerebrum and spinal cord;
- local, which consists in effect of current on osseous tissue, reconstruction of it's microcirculation and blood supply, effect on peripheral nerves, directed to injured extremity or internal organs.
Method of interstinal electrostimulation consists of two directions:
- Treatment of pain syndrome (treatment of headache; pain, caused by neck osteochondrosis; pain in shoulder joint, caused by scapulohumeral periarthrosis; pain in hip and knee joints, caused by deforming arthrosis; backache, caused by lumbar osteochondrosis).
- Electrostimulation of muscles, i.e. restoration of nerve's conductivity (contractions of joints, traumatic disease of spinal cord - strictly by indications; plexitis, muscle's atrophy).
Along with inserting electrodes between spinous processes of vertebrae trigger points are also stimulated.
Nowadays high efficiency of interstitial electrostimulation is proved for reduction of pain syndrome, caused by osteochondrosis of spine, scapulohumeral periarthrosis, deforming arthrosis of major joints, especially in severe and neglected cases.
One of main goals of nerve's function restoration is to increase the speed of reinnervation. Method of interstitial electrostimulation provides for getting electric current directly to vertebral canal, i.e. to outlet of spinal nerves. That is why the restoration of functional activity of muscles passes in shorter periond in comparison with traditional transcutaneous electrostimulation.
Case report
Patient D., age 21, diagnosis: combined trauma; compound splintered fracture of the right thigh in the middle third with segments' dislocation; simple splintered fracture of bones of right shank in the middle third with segments' dislocation; simple splintered fracture of the right humeral bone in the upper third with segments' dislocation; simple splinered fracture of bones of the right forearm with segments' dislocation; closed craniocerebral injury; cerebral contusion; contusion of the right lung; traumatic neuropathy of the right radial nerve. (Traffic accident 16.01.02). 24.01.02 was admitted to RSC RTO
Closed osteosynthesis with Ilizarov apparatus was carried out 24.01.02 on shank, thigh, humerus and forearm. 15.02.02 additional wires on forearm were installed. Apparatus from humerus was removed 13.05.02, from thigh - 10.06.02, from shank - 25.06.02
05.07.02 the patient was discharged from the Center in satisfactory condition. Axis of the right lower limb is correct. There were no angioneurologic disturbances. The range of motion in the right knee joint is 180º/135º. Axis of the right upper limb is correct. Forearm is fixed with Ilizarov apparatus. The range of motion in the right elbow joint is 170º/80º. Dorsal flexion of a hand 35-40º with muscular power 4 points. Abduction and opposition of a thumb of the right hand restored by activity. Sensitivity of hand's fingers preserved. The patient walked with loading, using one crutch. After two weeks the apparatus was removed from forearm.
From 02.09.02 to 28.11.02 the patient underwent treatment in the department of rehabilitation with following diagnosis: right-sided Erb-Duchenne's posttraumatic plexopathy, proximal paresis; tosttraumatic contracture of the right shoulder and elbow joints; posttraumatic extension contracture of the right knee joint.
Before treatment the range of motion in the right shoulder joint was: flexion - 60º, extension - 20º, abduction - 60º; in the right elbow joint - active flexion - 110º, passive flexion - 90º, extension - 180º. After course of conservative therapy (massage, remedial gymnastics, electrophoresis, paraffin, "Rikta", "Bioptron", interstitial electrostimulation, NSAID, vascular drugs, vitamins, proserin) active movements in shoulder joints appeared. From 18.09.02 to 24.10.02 the course of interstitial electrostimulation was carried out. The result is presented below.
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