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Denas device in complex therapy
of osteoarthrosis

Ozhighanov V.F.

City hospital no. 7,

Polyclinics no.1 Kirov, Russia


Osteoarthrosis deformans  is a dystrophic disease of joints caused by affection of the articular cartilage. Disease occurrence gradually increases as the people grow older and reaches its maximum at 60-65 years of age. Usually primary (idiopathic) and pulmonary osteoarthrosis are distinguished. Osteoarthrosis is called primary (idiopathic) when it was not possible to find out an immediate cause of its occurrence. Pulmonary osteoarthrosis is a consequence of different diseases, traumas and maldevelopment of the musculoskeletal system. At that, large joints of lower extremities (knee- and hip joints) are mainly affected as well as first metatarsophalangeal articulations. Several causes or risk factors of disease development can often be found in patients with osteoarthrosis. In addition, one patient can have a combination of both primary and pulmonary osteoarthrosis.


For  therapy of osteoarthrosis, complex therapy [5] is the most effective. Selection of therapy methods depends on the stage and period of the disease. During acute conditions of the disease a complex of measures is applied aimed at liquidation of the pain syndrome, improvement of the tissues trophism and blood circulation in the affected extremity, increase of the joint stability.


At early stages when the articular cartilage is not affected to a certain extent and with absence of contraindications, the so-called chondro-protective drug therapy is indicated. Therapeutic effect of these preparations in therapy of osteoarthrosis is associated with a favourable influence on the malfunctioning metabolism of the articular cartilage which slows the process progressing down. A clinically pronounced effect of these preparations is achieved only under conditions of their regular and long application [5, 6].


Non-efficiency or short-term effect of repeated course of conservative therapy under progressive disease is an indication for surgical therapy of osteoarthrosis. Basic criteria of the before-operational therapy to be considered inefficient are the following: continuous pains, increase of deformations and joint instability, restriction of joint movement. Modern methods of surgical therapy of osteoarthrosis are aimed at correction of existing biomechanical disorders. Under hip and knee joints osteoarthrosis a good clinical results with a positive roentgenological dynamics can be achieved with help of extraarticular correcting osteotomies. Their efficiency can be explained by influence on the basic links of the pathological process, improvement of centering of the mechanical axis of the extremity, joint congruence and stability, increase of the contact surface of the articulated joint surfaces, influence on active muscular components of joint stabilization, positive influence on the local microcirculation [2, 6].


Unfortunately, factors resulting in beginning and progressing of osteoarthrosis usually fail to be eliminated. Nevertheless, doctors should aim at their detection and correction. In addition, search for new economical and efficient methods of therapy and rehabilitation of patients is also of great importance. According to some sources [8, 9] a good clinical effect in patients with osteoarthrosis was achieved when applying dynamic electro stimulation (DENAS) in complex therapy. This method of therapy has some peculiarities, which enable to achieve a high efficiency and, at the same time, is very easy for application [I, 9]. During DENAS application, exposure is on biologically active zones and points with short current impulses of low frequency, which change their form in response to change of the skin electrical resistance in the subelectrode area.


During DENAS procedure, optimization of functioning of anti-nociceptive and trophic process in the pathologically changed tissues and organs is achieved due to local, segmental-reflex and general reactions. This provides for analgetic, anti-inflammatory, anti-edema and tropho-stimulating effects [1]. Thus, DENAS application for healing osteoarthrosis deformans is well-grounded theoretically.

Purpose of the present research was to assess DENAS efficiency and its influence on dynamics of clinical and laboratory indexes of patients with acute osteoarthrosis deformans of joints of extremities in the polyclinics conditions.


Materials and methods

31 patients with osteoarthrosis deformans of knee- and hip joints of I-II degree were examined. Patients were divided into groups by the method of random nonrepeated sampling. The patients were divided into two groups (main group - 19 people, and control group - 12 people). Average age of patients of the main group was 53.3 years (from 30 to 78 years), of the control group - 57.4 years (from 24 to 80 years). Average duration of the disease in the main group was 5.53±2.6 years, in the control group - 2.75±5.75 years (from one to 10 years). All patients passed an X-ray examination of joints. Before therapy patients of both groups had pain syndrome (100 %), edema of the affected joints (32.2 %), restriction of joints movement (100 %), reduction of the muscle strength (100 %). Dynamics of clinical symptomatology was assessed on the 5th and 15th days from the beginning of the therapy course. No significant differences by age. gender, degree of process activity and duration of the disease in the compared groups are present. Patients of the main and control groups had similar drug therapy; in addition, patients of the main group had dynamics electro stimulation (DENAS).


DENAS was applied in compliance with the recommended procedures [1]. Individual therapy recipe was selected for each patient at each therapy procedure. Zones were selected in accordance with the current clinical presentation. Skin surface over the affected joint was healed in the THERAPY mode at the maximum power level. Dynamics of the pain syndrome was the criteria of sufficiency of exposure on the said zone. therapy was finished when the pronounced analgetic effect was achieved (total relief or considerable reduction of pain). After that, the skin area symmetrical to the affected joint was healed in the TEST mode at the comfortable power level. The procedure was finished with therapy of universal zones; the trigger zones found, they were healed in the THERAPY mode at the comfortable power level (on average 3-5 minutes per each zone). Course apparatus therapy was finished after total regress of the pain syndrome.


Mathematical therapy of the research materials was carried out by methods of variation statistics [7] with application of the Microsoft Excel and Biostat software package. Significant differences were assessed by the Student's criterion.


Results of the research and discussion

In the main and control groups, dynamics of the following marker indexes for control of therapy efficiency were assessed: disorder (restriction) of affected joints movements, change of the muscular tone, pain syndrome, clinical analyses. Before the therapy course, 4 (21 %) of 19 patients of the main group had complaints of painfulness in the affected joints under loads, the rest of the group had a continuous pain syndrome. 4 patients (33.3 %) in the control group had a pain syndrome under loads and 8 had a continuous pain syndrome. In the main group, a significant positive dynamics was observed starting from the 3rd-4th day of the therapy beginning. Total pain relief was observed in all patients who had DENAS by the 6th day from the therapy beginning (5.21±0.77). Similar results in patients of the control group were achieved only by the 25th day of the therapy course (19.25±6.92). Other clinical symptoms had similar regress.


Significant differences in patients of the main group were observed when assessing the muscle strength and mobility disorders in the joint on the 5th day. In the control group, significant differences showed up only on the 15th day from the therapy beginning (Table).

Table. Dynamics of Marker Clinical Indexes in Patients who had DENAS therapy and in the Control Group

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No changes were registered in clinical analyses both in the main and in the control groups.


Conclusion

With application of dynamic electro stimulation (DENAS) for patients with osteoarthrosis a pronounced and fast analgetic effect was observed, regress of basic clinical symptoms was accelerated, therapy periods were reduced. Thus, we can make a conclusion that application of DENAS for patients with acute osteoarthrosis deformans of joints of the extremities is well grounded and advisable.


Taking into account chronic nature of the disease and relative simplicity of DENAS methods in combination with high efficiency of the therapy, further research should be aimed at development of optimal individual strategies of application of DENAS therapy at home depending on the stage of the disease.


Sources

1.  Manual on Dynamic Electroneurostimulating Therapy with DENAS apparatuses / V.V. Chemyshev, V.V. Malakhov, A.A. Vlasov. O.I. Rubtsova, N.I. Ivanova. - 2nd ed. - Ekaterinburg, 2003. - 248 p.

2.  V.N. Guriev. Coxarthrosis and its Surgical therapy / V.N. Gu-riev.-Tallinn. 1984.-243 p.

3.  Clinical Radiology and Nuclear Medicine / ed. by G.A. Zedgh-enidzhe. - M., 1984. - vol. 3. - 153 p.

4. A.A. Korzh. Dysplasia of the Joint - Dysontogenetic Arthrosis / A.A. Korzh, B.I. Siminach, Z.M. Miteleva // Orthopedy and Traumatology, 1987.-No. 6.-p. I.

5.  V.A. Nasonova. Clinical Rheumatology / V.A. Nasonova, M.G. Astapenko.-M., 1989.-p. 45.

6.  Rehabilitation of Patients with Arthrosis / ed. by I.I. Zhedenova. -L., 1982.-p. 59.

7.  S. Glanz. Medico-Biological Statistics / S.GIanz. - M.: "Praktika", 1999.-459 p.

8. Preliminary Assessment of Analgesic Effect of DENAS Apparatus in Patients with Osteoarthrosis Deformans/ТА. Zhuravleva, V.V. Malakhov, A.A. Safonov, V.V. Chernyshev//Thematic Collection: "DENS-therapy of pain syndromes of different genesis". - Ekaterinburg, 2003. -pp. 36-48.

9.  DENAS-therapy in healing Patients with Osteoarthrosis Deformans / S.D. Shoferova, A.G. Shiman, E.V Egorova, E.N. Andreeva // Materials of International Anniversary Symposium "Dynamic Electroneurostimulating Therapy. New Frontiers and Results of the Empirical Development Stage". - Ekaterinburg, 2003. - pp. 49-51.

Indexes

Main Group (DENAS)

n=19

Control Group

n=12

Before therapy

χ±δ

5th day

χ±δ

15th day

χ±δ

Before therapy

χ±δ

5th day

χ±δ

15th day

χ±δ

Restriction of joint movement, degrees

10.84±6.47

5.79±7.12

5.0±5.8

11.25±13.34

10.42±13.89

4.58±8.64

Reduction of muscle power, points

1.21±0.54

0.32±0.58

0.26±0.45

1.33±0.78

1.17±0.71

0.67±0.89

osteoarthrosis, therapy of osteoarthrosis, dystrophic disease of joints, knee joints osteoarthrosis, joints osteoarthrosis, electro stimulation