WO1988009190A1 - Method and apparatus for medical treatment of the pathological state of bones - Google Patents

Method and apparatus for medical treatment of the pathological state of bones Download PDF

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Publication number
WO1988009190A1
WO1988009190A1 PCT/BG1988/000001 BG8800001W WO8809190A1 WO 1988009190 A1 WO1988009190 A1 WO 1988009190A1 BG 8800001 W BG8800001 W BG 8800001W WO 8809190 A1 WO8809190 A1 WO 8809190A1
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WO
WIPO (PCT)
Prior art keywords
bone
medical treatment
impact waves
action
generator
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/BG1988/000001
Other languages
French (fr)
Inventor
Vyacheslav Deyanov Valchanov
Peter Marinov Mihaylov
Todor Krestev Patrashkov
Stoyan Slavchev Manolov
Todor Petkov Kerin
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Vissh Voennomedicinski Institut
Original Assignee
Vissh Voennomedicinski Institut
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Vissh Voennomedicinski Institut filed Critical Vissh Voennomedicinski Institut
Priority to KR1019890700102A priority Critical patent/KR890701167A/en
Priority to BR888807063A priority patent/BR8807063A/en
Priority to KR1019890700102A priority patent/KR930001306B1/en
Priority to HU883920A priority patent/HU203483B/en
Publication of WO1988009190A1 publication Critical patent/WO1988009190A1/en
Priority to NO890224A priority patent/NO890224D0/en
Priority to FI890262A priority patent/FI890262A0/en
Priority to DK022489A priority patent/DK22489A/en
Priority to SU894614504A priority patent/RU1836056C/en
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/02—Details
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/225—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for for extracorporeal shock wave lithotripsy [ESWL], e.g. by using ultrasonic waves
    • A61B17/2255—Means for positioning patient, shock wave apparatus or locating means, e.g. mechanical aspects, patient beds, support arms or aiming means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/22004—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for using mechanical vibrations, e.g. ultrasonic shock waves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N7/00—Ultrasound therapy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00137—Details of operation mode
    • A61B2017/00154—Details of operation mode pulsed

Definitions

  • This invention relates to a method and an apparatus for medical treatment of bone pathology which finds application in orthopaedic traumatologic practice for medical treatment of pseudoarthrosis, delayed consolidation, bone deformations, correction of the length of long tubular bones, performing arthrodesis, acceleration of the normal bone knit, treatment of bone tumours, aseptic necrosis, delay of the bone growth (epiphysiodesis), a.o.
  • a known method for medical treatment of pseudoarthrosis, delayed consolidation and bone deformations after anesthesis the skin of the limb in the place of injury is cleaned as for operation and then the bone is drilled through the skin in several places and the limb is immobilized (1).
  • Another known operative method for medical treatment consists in that, after anesthesis of the limb, the latter is fixed to the operation table, there is performed by operation a penetration to the bone, the periosteum is opened and the adges of the injured bone ends are scraped, while in case of bone deformations a bone triangle is cut out. A proper or preserved bone transplantate is put in place. The fragments ire aligned and are osteosynthesized with different materials. The periosteum and the soft tissues are restored and finally there is effected an external immobilization for a period of from 60 to 180 days (2).
  • a known apparatus for the fragmentation of kidney stones comprises a generator of impact waves, over which there is disposed the patient carriage, underneath which there is fastened the head of an ultrasonic emitter, the vertical axis of which coincides with the vertical axis of the generator of impact waves and passes throug the zone of fragmentation of the kidney stones.
  • the generator of impact waves consists of a housing, shaped as a vessel containing an acoustic liquid, in the bottom end of which there is disposed a discharger which is covered by the liquid contained in the housing. and in its top end there is provided a flexible membrane (3).
  • the object is achieved by a method for medical treatment of bone pathology in which, after anesthesis, the limb is fixed to the carrying carriage of the apparatus and is finally immobilized.
  • the limb is fixed to the carrying carriage of the apparatus and is finally immobilized.
  • it is subjected once, consecutively and extracorporally to the action of 300 to 6000 impact waves with a frequency of 0.5 to 4 per second, at a pressure in the focus of from 700 to 2500 bars, at a pulse duration of from 0 5 to 4 microseconds during 10 to 120 minutes, with a subsequent immobilization fro 15 to 90 days.
  • the object is also achieved by a method for medical treatment of bone pathology, pseudoarthrosis, delayed consolidation and bone deformations, in which the action on the pathological place is effected by impact waves of from 1000 to 5000 impacts with a frequency of 1 to 2 per second, at a pressure of from 1200 to 2000 bars and pulse duration of from 1.5 to 3 microseconds during 20 to 110 minutes, with a subsequent immobilization of from 40 to 90 days.
  • the object is also achieved by another method for medical treatment of bone pathology for the correction of the length of long tubular bones, in which a device for extrafocal fixation is placed on the bone and the pathological place is subjected to the action of impact waves of from 1000 to 6000 impacts with a frequency of 1 to 3 per second, at a pressure of from 1100 to 1700 bars and a pulse duration of from 1 to 3.5 microseconds during 30 to 115 minutes and subsequent immobilization of from 60 to 85 days.
  • the object is also achieved by a method for medical treatment of bone pathology for extracorporal performance of arthrodesis, in which the pathological place is subjected to the action of impact waves of from 750 to 6000 impacts with a frequency of from 0.5 to 3.5 per second, at a pressure of from 1200 to 2500 bars and pulse duration of from 0.5 to 2.5 microseconds during 15 to 120 minutes , and subsequent Immobilization of from 30 to 80 days.
  • the object is also achieved by a method for medical treatment of bone pathology for acceleration of the normal bone knit, in which the pathological place is subjected to the action of impact waves of from 300 to 3000 impacts, with a frequency of from 1 to 3.5 per second at a pressure of from 700 to 1500 bars and a pulse duration of from 1.5 to 4 microseconds during 10 to 90 minutes, and subsequent immobilization of from 15 to 60 days.
  • the object is also achieved by a method for medical treatment of bone pathology in case of bone tumours, in which the pathological place is subjected to the action of impact waves of from 500 to 5000 impacts with a frequency of from 0.5 to 4 per second, at a pressure of from 850 to 1700 bars and pulse duration of from 1.5 to 3. 5 microseconds during 15 to 95 minutes, and subsequent immobilisation of from 15 to 60 days.
  • the object is also achieved by a method for medical treatment of bone pathology in case of delay of the bone growth (epiphysiodesis), in which the pathological place is subjected to the action of impact waves of from 1000 to 5500 impacts with a frequency of from 1 to 4 per second at a pressure of from 950 to 1900 bars and a pulse duration of from 0.5 to 3.5 microseconds during 20 to 110 minutes, and subsequent immobilization of from 15 to 90 days.
  • the object is also achieved by a method of medical treatment of bone pathology in case of aseptic necrosis, in which the pathological place is subjected to the action of impact waves of from 350 to 4000 impacts with a frequency of from 1 to 2.5 per second at a pressure of from 750 to 1600 bars and a pulse duration of from 1.5 to 3 microseconds during 10 to 105 minutes, and subsequent immobilization of from 15 to 30 days.
  • an apparatus which comprises a housing, inside which there is disposed a generator of impact waves, to the base: of which there are fastened guiding rolls which are in contact with the internal surface of the outer housing, opposite to which there is disposed a x-ray generator.
  • the top end of the generator of impact waves is shaped as a vessel containing a transmitting medium, which is an acoustic liquid, and it covers the discharger fastened to the bottom of the vessel, while in its top end there is disposed a flexible membrane.
  • a light diaphragm Over the generator of impact waves there is disposed a light diaphragm, and over it there is disposed an electronic optical converter, which is connected to a television camera, the longitudinal axis of which coincides with the longitudinal axis of the x-ray generator, and its point of intersection with the longitudinal axis of the light diaphragm forms the point of action.
  • a protective barrier To the outer housing, behind the television camera, there is positioned a protective barrier.
  • the object is also achieved by an apparatus in which the generator of impact waves is rigidly connected to the central part of a earrying arm, which can rotate around its axis and is connected to the external housing.
  • the advantages of the invention lie in that the medical treatment is non-operative, extra-corporal, ambulatory and more harmless for the health of the patient.
  • the danger of complications is reduced to minimum.
  • the duration of treatment is reduced, too.
  • the apparatus is compact, convenient and easy to attend and repair.
  • Fig.1 is a general view of the apparatus
  • Fig.2 is a general view of the apparatus with block circuit
  • Fig.3 is a general view of the apparatus with block circuit a second modification
  • Fig.4 is a general view of s radius bone with pseudoarthrosis
  • Fig.5 shows how a radius bone with pseudoarthrosis is subjected to the action of impact waves
  • Fig.6 is a general view of a radius bone with pseudoarthros after the action of impact waves
  • Fig.7 is a general view of a deformed radius bone
  • Fig.8 shows how the deformed radius bone is subjected to the action of impact waves
  • Fig.9 is a general view of the deformed radius bone after the action and correction
  • Fig.10 is a general view of the bone after knit;
  • Fig. 1 1 shows a pathologically shortened radius bone placed in the apparatus for extrafocal fixation:
  • Fig. 12 shows the bone placed in the apparatus with diagrammatic illustration of the arrangement for action
  • Fig. 13 shows the process of correction of the length of a radius bone according to Fig. 12 ;
  • Fig. 14 shows the bone illustrated in Fig. 13 - elongated and knit in normal state.
  • the apparatus for medical treatment of bone pathology comprises an outer housing 1, inside which there are disposed a generator of impact waves, to the base of which there are fastened guiding rolls 3 which are in contact with the internal surface 4 of the outer housing 1, opposite to which there is disposed a x-ray generator 5.
  • the top end of the generator of impact waves 2 is shaped as a vessel 6 which contains a transmitting medium, which is an acoustic liquid 7 - water in this case, and it covers the high-voltage electrode 8 fastened to the bottom of the vessel 6, while in its top end there is disposed a flexible membrane 24.
  • a patient carriage 9 Over the generator of impact waves 2 there is disposed a patient carriage 9, opposite to which and over the generator of impact waves 2 there is disposed a light diaphragm 10, and over it there is disposed an electronic optical converter 11, to which thete is connected a television camera 12.
  • the longitudinal axis 13 of which coincides with the longitudinal axis of the x-ray generator 5, and its point of intersect ion with the longitudinal axis 14 of the light diaphragm 10 forms the point of action 15.
  • a protective barrier 16 To the outer housing 1, behind the television camera 12, there is positioned a protective barrier 16.
  • the apparatus is connected to a block circuit which consists of a supply block 17, the output of which is connected to the block for for centering the patient 18, and its output is connected to the carriage with the object 9.
  • the output of the supply block 17 is also connected to the television block 19, while the latter, for its part, is connected to the monitor 20, the television camera 12 and the block of the electronic optical converter 21 which, for its part, is connected is connected via its output to the block of the x-ray system 22, which is connected to the input of the x-ray generator 5.
  • the supply block 17 is directly connected to the block of the high-voltage generator 23 of the generator of impact waves 2, which are interconnected.
  • the television block 19, the block of the electronic optical converter 21 and the x-ray block 22 are provided with feedforwards and feedbacks.
  • the apparatus for medical treatment of bone pathology which consists of an outer housing 1, to which there fastened movably in its one end a carrying arm , while to Its other end there is attached the generator of electrohydraulic waves 2.
  • an arch-shaped arm 25 Between the electrohydraulic generator 2 and the outer housing 1 there is fastened rigidly to the arm 14 an arch-shaped arm 25, to the bottom end of which there is fastened rigidly the x-ray generator 5, while to its top end there is fastened rigidly the electronic optical converter 11, to which the television camera 12 is fastened rigidly.
  • the carrying arm 14 can rotate around its own axis at ⁇ 30°.
  • a vessel for the transmitting medium 6 which contains an acoustic liquid 7 - in this case water, and it covers the high-voltage electrode 8 which is fastened to the bottom of the vessel 6 for the transmitting medium, and in its top end there is fastened a flexible membrane 24.
  • the carriage for centering the patient 9 onto w hich the patient is lying with the point of action 15 .
  • a protective barri er 1 6 To the outer housing 1 there is fastene d rigi dly a protective barri er 1 6 .
  • the apparatus is connected to a block circuit , which consi sts of a supply block 17 , the output of which is connected to the block for centering the patient 18 , while its output is connected to the carriage with the object 9.
  • the output of the supply block 17 is connected to the television block 19 which , for its part , is connected to the monitor 20 , the television camera 12 and the block of the electronic optical converter 21 , which, is connected with its output to the block of the x-ray system 22 , which is connected to the input of the x-ray generator 5 .
  • the supply block 17 is directly connected to the block of the high-voltage generator 23 , whi ch is connected to the generator of electrohydraulic waves 2.
  • the television block 19 , the electronic optical converter 21 and the x-ray system 22 are provi ded wi th feedforwards a nd feedbacks .
  • FIG.4 shows a pseudoarthrosi s or delaye d consoli dation of a radius bone with bottom edge 26 and upper edge 27.
  • a regional intravenous anesthesis of the limb with non-healed radius bone is paerformed , and the latter is fixed to the patient carriage 9 shown in Fig. 1 , being in contact with the flexible membrane 24 as shown in Figures 1 and 5 .
  • electrohydraulic impacts with frequency 2 impacts per second at a pressure of 1 300 bars and a pulse duration of 3 microseconds during 20 minutes are also applied to the upper bone edge 27.
  • Fig.6 shows the result of the action of the electrohydraulic impact waves with formati on of bone sand admixed with blood coming from the opene d mi crovessels and microfissures of the edges of the bone fragments 26 and 27.
  • FIG.7 shows the deformation of a radius bone 28.After performing a regional intravenous anesthesis of the limb with deformed radius bone, the latter is fixed to the patient carriage 9 shown in Fig.1, being In contact with the flexible membrane 24 as shown in Figures 1 and 8. After positioning, the point of action 15 is set up on the bone deformation 28. There are delivered 3000 electrohydraulic impacts with a frequency of 2 impacts per second at a pressure of 1500 bars and pulse duration of 3 microseconds during 50 minutes.
  • Fig.9 shows the result of the action of the electrohydraulic impact waves with formation of fracture of the deformation 29 at preserved periosteum 30 a nd subsequent manual correction of the deformation. After the termination of the procedure, there is carried out an external immobilization of the limb of the patient, which he must bear for 90 days.
  • Fig.10 shows the result with knit in straight position deformation of the radius bone 28.
  • FIG.11 shows a shortened tubular bone 31 mounted on an apparatus for extrafocal fixation 32, and before its mounting there is performed a regional intravenous anesthesis for upper limb or peridural anesthesis for bottom limb.
  • the limb is fixed to the patient carriage 9 shown in Fig.1 where it comes in contact with the flexible membrane 24 shown in Fig.12.
  • the point of action 15 is set up on the tubular bone 31 subsequently in three spots , the distance between them being up to 20 mm, and in each spot there are delivered 1000 electrohydraulic impacts for the upper limb and 1900 electrohydraulic impacts for the bottom limb.
  • Fig.12 shows the result of the action in obtaining a fracture 33 of bone 31 at preserving the periosteum 30.
  • Fig.13 shows the elongation of the bone 31, consisting of two parts 34 and 35 after a fracture, which are extended by means of the apparatus 32 daily during 20 days until reaching the length of the sound limb. Between both parts 34 and 35 of the bone 31 there is obtained a gap 36, which is filled with blood and bone sand as a result of the action.
  • the apparatus for medical treatment of bone pathology operates as follows:
  • a voltage is supplied to the block for centering the patient 18 and, as a result, the patient carriage with the object 9 is centered. Then the voltage is supplied to the x-ray block 22 which actuates the x-ray generator 5.
  • the rays produced by the x-ray generator 5 are pre agated along its longitudinal axis 13, they pass through the point of action 15 and reach the electronic optical converter 11 , in the output of which there is obtained the image of action 15.
  • the image is received by the television camera 12, the signal of which is transmitted to the television block 19, where it is processed and then transmitted to the monitor 20 and via the feedbacks to the block of the electronic optical converter 21 and the block of the television system 22.
  • the voltage supplied by the supply block 17 passes through the block of the high-voltage generator 23 for the supply of the generator of impact waves 2. After entering a command in the block of the high-voltage generator 23 by electrode 8, the generator of impact waves 2 begins to generate impact waves, which via the acoustic medium 7 get into the point of action 15 of the object 9. This cycle is repeated until the necessary healing effect is achieved.
  • the rays pass through the point of action 15, the rays reach the electronic optical converter 11, at the output of which there is obtained the image of the object of action 15.
  • the image is received by the television camera 12, the signal of which is transmitted to the television block 19, where it is processed and transmitted to the monitor 20 and via the feedbacks - to the block of the elctronic optical converter 21 and the block of the x-ray system 22.
  • the voltage supplied by the supply block 17 passes through the block of the high-voltage generator 23 for supplying the generator of impact waves 2. After entering a command in the block of the high-voltage generator 23 by electrode 8, the generator of impact waves 2 begins to generate Impact waves, which via the acoustic medium 7 get into the point of action 15 of the object 9. This cycle is repeated until the necessary healing effect is achieve
  • the impact waves can also be produced by an ultrasonic generator of impact waves, a magnetostriction generator of impact waves or a microexplosive generator of impact waves.

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Abstract

Method and apparatus for medical treatment of pseudoarthrosis, delayed consolidation, bone deformations, correction of the length of long tubular bones, performing arthrodesis, acceleration of the normal bone knit, treatment of bone tumours, aseptic necrosis, delay of bone growth, a.o. in which, after anesthesis, the limb of the patient is fixed to the carrying carriage (9) of the apparatus. After centering of the pathological place, it is subjected once, consecutively and extracorporally to the action of impact waves with different frequencies and pressures at different pulse duration for different period of times, and this is followed by subsequent immobilization for a longer period. The apparatus comprises a generator of impact waves (2) disposed under the patient carriage (9), an X-ray generator (5), a television camera (12) and an electronic optical converter (11) on the longitudinal axis (13) of the X-ray generator (5) and a light diaphragm (10). The intersection point of the longitudinal axes of the X-ray generator (5) and of the light diaphragm (10) forms the point of action (15) of the impact waves.

Description

Method and apparatus for medical treatment of the pathological state of bones.
This invention relates to a method and an apparatus for medical treatment of bone pathology which finds application in orthopaedic traumatologic practice for medical treatment of pseudoarthrosis, delayed consolidation, bone deformations, correction of the length of long tubular bones, performing arthrodesis, acceleration of the normal bone knit, treatment of bone tumours, aseptic necrosis, delay of the bone growth (epiphysiodesis), a.o. In a known method for medical treatment of pseudoarthrosis, delayed consolidation and bone deformations, after anesthesis the skin of the limb in the place of injury is cleaned as for operation and then the bone is drilled through the skin in several places and the limb is immobilized (1).
The drawbacks of this method lie in that it is invasive and frequently there occur complications, such as suppurations, osteomyelitis, There are not provided proper conditions for consolidation and, therefore, the method is not sufficiently effective.
Another known operative method for medical treatment consists in that, after anesthesis of the limb, the latter is fixed to the operation table, there is performed by operation a penetration to the bone, the periosteum is opened and the adges of the injured bone ends are scraped, while in case of bone deformations a bone triangle is cut out. A proper or preserved bone transplantate is put in place. The fragments ire aligned and are osteosynthesized with different materials. The periosteum and the soft tissues are restored and finally there is effected an external immobilization for a period of from 60 to 180 days (2).
The drawbacks of this method lie in that it is invasive with all post-operation complications possible to occur. There is required a prolonged stay in hospital. After the healing of the injury, there is necessary a second operation for the removal of the osteosythesizing materials. In some cases there are necessary several operative interventions in the event of recidive.
A known apparatus for the fragmentation of kidney stones, the design of which is similar to that of the apparatus for medical treatment of bone pathology according to the present invention, comprises a generator of impact waves, over which there is disposed the patient carriage, underneath which there is fastened the head of an ultrasonic emitter, the vertical axis of which coincides with the vertical axis of the generator of impact waves and passes throug the zone of fragmentation of the kidney stones. The generator of impact waves consists of a housing, shaped as a vessel containing an acoustic liquid, in the bottom end of which there is disposed a discharger which is covered by the liquid contained in the housing. and in its top end there is provided a flexible membrane (3).
The drawback of this device lie in that in cannot be used for medical treatment of bone pathology.
It is therefore a general object of this invention to develop a method for medical treatment of bone pathology which is non-operative, extracorporal, ambulatory, and can shorten the duration of the recovery process.
It is another object of this invention to develop an apparatus for the treatment of bone pathology which is of compact design and makes possible a quick and painl 's carrying out of the treatment.
The object is achieved by a method for medical treatment of bone pathology in which, after anesthesis, the limb is fixed to the carrying carriage of the apparatus and is finally immobilized. According to the invention, after the fixation of the limb and the centering of the pathological place and before the immobilization, it is subjected once, consecutively and extracorporally to the action of 300 to 6000 impact waves with a frequency of 0.5 to 4 per second, at a pressure in the focus of from 700 to 2500 bars, at a pulse duration of from 0 5 to 4 microseconds during 10 to 120 minutes, with a subsequent immobilization fro 15 to 90 days.
The object is also achieved by a method for medical treatment of bone pathology, pseudoarthrosis, delayed consolidation and bone deformations, in which the action on the pathological place is effected by impact waves of from 1000 to 5000 impacts with a frequency of 1 to 2 per second, at a pressure of from 1200 to 2000 bars and pulse duration of from 1.5 to 3 microseconds during 20 to 110 minutes, with a subsequent immobilization of from 40 to 90 days.
The object is also achieved by another method for medical treatment of bone pathology for the correction of the length of long tubular bones, in which a device for extrafocal fixation is placed on the bone and the pathological place is subjected to the action of impact waves of from 1000 to 6000 impacts with a frequency of 1 to 3 per second, at a pressure of from 1100 to 1700 bars and a pulse duration of from 1 to 3.5 microseconds during 30 to 115 minutes and subsequent immobilization of from 60 to 85 days.
The object is also achieved by a method for medical treatment of bone pathology for extracorporal performance of arthrodesis, in which the pathological place is subjected to the action of impact waves of from 750 to 6000 impacts with a frequency of from 0.5 to 3.5 per second, at a pressure of from 1200 to 2500 bars and pulse duration of from 0.5 to 2.5 microseconds during 15 to 120 minutes , and subsequent Immobilization of from 30 to 80 days.
The object is also achieved by a method for medical treatment of bone pathology for acceleration of the normal bone knit, in which the pathological place is subjected to the action of impact waves of from 300 to 3000 impacts, with a frequency of from 1 to 3.5 per second at a pressure of from 700 to 1500 bars and a pulse duration of from 1.5 to 4 microseconds during 10 to 90 minutes, and subsequent immobilization of from 15 to 60 days.
The object is also achieved by a method for medical treatment of bone pathology in case of bone tumours, in which the pathological place is subjected to the action of impact waves of from 500 to 5000 impacts with a frequency of from 0.5 to 4 per second, at a pressure of from 850 to 1700 bars and pulse duration of from 1.5 to 3. 5 microseconds during 15 to 95 minutes, and subsequent immobilisation of from 15 to 60 days.
The object is also achieved by a method for medical treatment of bone pathology in case of delay of the bone growth (epiphysiodesis), in which the pathological place is subjected to the action of impact waves of from 1000 to 5500 impacts with a frequency of from 1 to 4 per second at a pressure of from 950 to 1900 bars and a pulse duration of from 0.5 to 3.5 microseconds during 20 to 110 minutes, and subsequent immobilization of from 15 to 90 days.
The object is also achieved by a method of medical treatment of bone pathology in case of aseptic necrosis, in which the pathological place is subjected to the action of impact waves of from 350 to 4000 impacts with a frequency of from 1 to 2.5 per second at a pressure of from 750 to 1600 bars and a pulse duration of from 1.5 to 3 microseconds during 10 to 105 minutes, and subsequent immobilization of from 15 to 30 days.
The object is also achieved by an apparatus which comprises a housing, inside which there is disposed a generator of impact waves, to the base: of which there are fastened guiding rolls which are in contact with the internal surface of the outer housing, opposite to which there is disposed a x-ray generator. The top end of the generator of impact waves is shaped as a vessel containing a transmitting medium, which is an acoustic liquid, and it covers the discharger fastened to the bottom of the vessel, while in its top end there is disposed a flexible membrane. Over the generator of impact waves there is disposed a light diaphragm, and over it there is disposed an electronic optical converter, which is connected to a television camera, the longitudinal axis of which coincides with the longitudinal axis of the x-ray generator, and its point of intersection with the longitudinal axis of the light diaphragm forms the point of action. To the outer housing, behind the television camera, there is positioned a protective barrier.
The object is also achieved by an apparatus in which the generator of impact waves is rigidly connected to the central part of a earrying arm, which can rotate around its axis and is connected to the external housing.
The advantages of the invention lie in that the medical treatment is non-operative, extra-corporal, ambulatory and more harmless for the health of the patient. The danger of complications is reduced to minimum. The duration of treatment is reduced, too. The apparatus is compact, convenient and easy to attend and repair.
For a better understanding of the invention reference should be made to the accompanying drawings in which there is illustrated and explained a preferred embodimant of the invention. In the drawings:
Fig.1 is a general view of the apparatus;
Fig.2 is a general view of the apparatus with block circuit;
Fig.3 is a general view of the apparatus with block circuit a second modification;
Fig.4 is a general view of s radius bone with pseudoarthrosis;
Fig.5 shows how a radius bone with pseudoarthrosis is subjected to the action of impact waves;
Fig.6 is a general view of a radius bone with pseudoarthros after the action of impact waves;
Fig.7 is a general view of a deformed radius bone;
Fig.8 shows how the deformed radius bone is subjected to the action of impact waves;
Fig.9 is a general view of the deformed radius bone after the action and correction;
Fig.10 is a general view of the bone after knit; Fig. 1 1 shows a pathologically shortened radius bone placed in the apparatus for extrafocal fixation:
Fig. 12 shows the bone placed in the apparatus with diagrammatic illustration of the arrangement for action;
Fig. 13 shows the process of correction of the length of a radius bone according to Fig. 12 ;
Fig. 14 shows the bone illustrated in Fig. 13 - elongated and knit in normal state.
The apparatus for medical treatment of bone pathology comprises an outer housing 1, inside which there are disposed a generator of impact waves, to the base of which there are fastened guiding rolls 3 which are in contact with the internal surface 4 of the outer housing 1, opposite to which there is disposed a x-ray generator 5. The top end of the generator of impact waves 2 is shaped as a vessel 6 which contains a transmitting medium, which is an acoustic liquid 7 - water in this case, and it covers the high-voltage electrode 8 fastened to the bottom of the vessel 6, while in its top end there is disposed a flexible membrane 24. Over the generator of impact waves 2 there is disposed a patient carriage 9, opposite to which and over the generator of impact waves 2 there is disposed a light diaphragm 10, and over it there is disposed an electronic optical converter 11, to which thete is connected a television camera 12. the longitudinal axis 13 of which coincides with the longitudinal axis of the x-ray generator 5, and its point of intersect ion with the longitudinal axis 14 of the light diaphragm 10 forms the point of action 15. To the outer housing 1, behind the television camera 12, there is positioned a protective barrier 16. The apparatus is connected to a block circuit which consists of a supply block 17, the output of which is connected to the block for for centering the patient 18, and its output is connected to the carriage with the object 9. The output of the supply block 17 is also connected to the television block 19, while the latter, for its part, is connected to the monitor 20, the television camera 12 and the block of the electronic optical converter 21 which, for its part, is connected is connected via its output to the block of the x-ray system 22, which is connected to the input of the x-ray generator 5. The supply block 17 is directly connected to the block of the high-voltage generator 23 of the generator of impact waves 2, which are interconnected. The television block 19, the block of the electronic optical converter 21 and the x-ray block 22 are provided with feedforwards and feedbacks.
The is also explained by means of another preferred embodiment of the apparatus for medical treatment of bone pathology, which consists of an outer housing 1, to which there fastened movably in its one end a carrying arm , while to Its other end there is attached the generator of electrohydraulic waves 2. Between the electrohydraulic generator 2 and the outer housing 1 there is fastened rigidly to the arm 14 an arch-shaped arm 25, to the bottom end of which there is fastened rigidly the x-ray generator 5, while to its top end there is fastened rigidly the electronic optical converter 11, to which the television camera 12 is fastened rigidly. The carrying arm 14 can rotate around its own axis at ± 30°. To the generator of electrohydraulic waves 2 there is fastened rigidly a vessel for the transmitting medium 6, which contains an acoustic liquid 7 - in this case water, and it covers the high-voltage electrode 8 which is fastened to the bottom of the vessel 6 for the transmitting medium, and in its top end there is fastened a flexible membrane 24. Opposite to the generator of electrohydraulic waves 2 there is disposed the carriage for centering the patient 9, onto w hich the patient is lying with the point of action 15 . To the outer housing 1 there is fastene d rigi dly a protective barri er 1 6 . The apparatus is connected to a block circuit , which consi sts of a supply block 17 , the output of which is connected to the block for centering the patient 18 , while its output is connected to the carriage with the object 9. The output of the supply block 17 is connected to the television block 19 which , for its part , is connected to the monitor 20 , the television camera 12 and the block of the electronic optical converter 21 , which, is connected with its output to the block of the x-ray system 22 , which is connected to the input of the x-ray generator 5 . The supply block 17 is directly connected to the block of the high-voltage generator 23 , whi ch is connected to the generator of electrohydraulic waves 2. The television block 19 , the electronic optical converter 21 and the x-ray system 22 are provi ded wi th feedforwards a nd feedbacks .
The invention is also explained by means of the following examples of medical treatment of bone pathology:
EXAMPLE 1. Fig .4 shows a pseudoarthrosi s or delaye d consoli dation of a radius bone with bottom edge 26 and upper edge 27. A regional intravenous anesthesis of the limb with non-healed radius bone is paerformed , and the latter is fixed to the patient carriage 9 shown in Fig. 1 , being in contact with the flexible membrane 24 as shown in Figures 1 and 5 . After the positioning of the point of action 15 there are delivered on the bone edge 26 1200 electrohydraulic impacts with frequency 2 impacts per second at a pressure of 1 300 bars and a pulse duration of 3 microseconds during 20 minutes . The same actions are also applied to the upper bone edge 27. Fig.6 shows the result of the action of the electrohydraulic impact waves with formati on of bone sand admixed with blood coming from the opene d mi crovessels and microfissures of the edges of the bone fragments 26 and 27. After the termination of the procedure the limb of the patient is released from the patient carriage 9 and there follows an external immobilization for 80 days.
EXAMPLE 2. Fig.7 shows the deformation of a radius bone 28.After performing a regional intravenous anesthesis of the limb with deformed radius bone, the latter is fixed to the patient carriage 9 shown in Fig.1, being In contact with the flexible membrane 24 as shown in Figures 1 and 8. After positioning, the point of action 15 is set up on the bone deformation 28. There are delivered 3000 electrohydraulic impacts with a frequency of 2 impacts per second at a pressure of 1500 bars and pulse duration of 3 microseconds during 50 minutes. Fig.9 shows the result of the action of the electrohydraulic impact waves with formation of fracture of the deformation 29 at preserved periosteum 30 a nd subsequent manual correction of the deformation. After the termination of the procedure, there is carried out an external immobilization of the limb of the patient, which he must bear for 90 days. Fig.10 shows the result with knit in straight position deformation of the radius bone 28.
EXAMPLE 3. Fig.11 shows a shortened tubular bone 31 mounted on an apparatus for extrafocal fixation 32, and before its mounting there is performed a regional intravenous anesthesis for upper limb or peridural anesthesis for bottom limb. The limb is fixed to the patient carriage 9 shown in Fig.1 where it comes in contact with the flexible membrane 24 shown in Fig.12. After positioning, the point of action 15 is set up on the tubular bone 31 subsequently in three spots , the distance between them being up to 20 mm, and in each spot there are delivered 1000 electrohydraulic impacts for the upper limb and 1900 electrohydraulic impacts for the bottom limb.Fig.12 shows the result of the action in obtaining a fracture 33 of bone 31 at preserving the periosteum 30. Fig.13 shows the elongation of the bone 31, consisting of two parts 34 and 35 after a fracture, which are extended by means of the apparatus 32 daily during 20 days until reaching the length of the sound limb. Between both parts 34 and 35 of the bone 31 there is obtained a gap 36, which is filled with blood and bone sand as a result of the action. After the elapsing of the 20 days, the apparatus with the elongated bone remains for immobilization until the total consolidation for 4 months; the healed and elongated zone of the bone 37 is shown in Fig.14, the length of the bone 31 being normalized. The apparatus for medical treatment of bone pathology according to the invention operates as follows:
After the switching-on of the supply block 17, a voltage is supplied to the block for centering the patient 18 and, as a result, the patient carriage with the object 9 is centered. Then the voltage is supplied to the x-ray block 22 which actuates the x-ray generator 5. The rays produced by the x-ray generator 5 are pre agated along its longitudinal axis 13, they pass through the point of action 15 and reach the electronic optical converter 11 , in the output of which there is obtained the image of action 15. The image is received by the television camera 12, the signal of which is transmitted to the television block 19, where it is processed and then transmitted to the monitor 20 and via the feedbacks to the block of the electronic optical converter 21 and the block of the television system 22. The voltage supplied by the supply block 17 passes through the block of the high-voltage generator 23 for the supply of the generator of impact waves 2. After entering a command in the block of the high-voltage generator 23 by electrode 8, the generator of impact waves 2 begins to generate impact waves, which via the acoustic medium 7 get into the point of action 15 of the object 9. This cycle is repeated until the necessary healing effect is achieved.
In a second modification of the apparatus, after switching-on the supply block 17, there is supplied a voltage to the block for centering the patient 18 and, as a result, the patient carriage with the object 9 is centered, Then a voltage is supplied to the x-ray system 22 which actuates the generator of x-rays 5. The rays produced by the x-ray generator 5 are propagated along its longitudinal axis 13. B y rotation of the carrying arm 24 around its axis 14 there is achieved a rotation of the longitudinal axis 13 at ±30 degrees with respect to the axis 14, which is an axis of the generator of impact waves, thus achieving an accurate determination of the spot of action 15. Passing through the point of action 15, the rays reach the electronic optical converter 11, at the output of which there is obtained the image of the object of action 15. The image is received by the television camera 12, the signal of which is transmitted to the television block 19, where it is processed and transmitted to the monitor 20 and via the feedbacks - to the block of the elctronic optical converter 21 and the block of the x-ray system 22. The voltage supplied by the supply block 17 passes through the block of the high-voltage generator 23 for supplying the generator of impact waves 2. After entering a command in the block of the high-voltage generator 23 by electrode 8, the generator of impact waves 2 begins to generate Impact waves, which via the acoustic medium 7 get into the point of action 15 of the object 9. This cycle is repeated until the necessary healing effect is achieve
The impact waves can also be produced by an ultrasonic generator of impact waves, a magnetostriction generator of impact waves or a microexplosive generator of impact waves.
The scope of the invention is not limited only for the aforementioned generator types, It should be understood that there can also be used other generators which can generate impact waves and can be used for medical treatment of bone pathology.
Cited literature:
1. Diffenbach-Beck. Cited in: I. Koptchev, "Trawmatologya na oporno-dvigatelnya aparat", Sofia, Medizina i Fizkoultoura, 1976, p.137.
2. R.Watson-Jo,ne , "Fractures and Joint Injuries", vol. I, 1976, pp.22-50.
3. USA Patent No. 4610249.

Claims

C L A I M S :
1. method for medical treatment of bone pathology in which there is first performed an anesthesis, then the limb is fixed and finally immobilized, wh e r e i n after the fixation of the limb, the pathologic place is centered and, before the immobilization, it is subjected once, consecutively and extracorporally at least in one point to the action of impact waves of from 300 to 6000 impacts with a frequency of impacts of from 0.5 to 4 per second at a pressure of from 700 to 2500 bars and a pulse duration of from 0. 5 to
4 microseconds during 10 to 120 minutes, witn a subsequent immobilization fora periodof from 15 to 90 days.
2. Method for medical treatment of bone pathology according to claim 1, wherein the action on the pathological place is effected by impact waves of from 1000 to 5000 impacts with a frequency of from 1 to 2 per second at a pressure of from 1200 to 2000 bars,and pulse duration of from 1.5 to 3 microseconds during 20 to 110 minutes, with a subsequent immobilizatlonfor a period of from 40 to 90 days.
3. Method for the medical treatment of bone pathology according to claim 1, wherein the bone is fixed with an extrafocal fixator and the pathological place is subjected to the action of impact waves of from 1000 to 6000 impacts with a frequency of from 1 to 3 per second at a pressure of from 1100 to 1700 bars and pulse duration of from 1 to 3.5 microseconds during 30 to 115 minutes with a subsequent immobilization for a period of from 60 to 85 days.
4. Method for medical treatment of bone pathology according to claim 1, wnerein the pathological place is subjected to the action of impact waves of from 750 to 6000 impacts with a frequency of from 0.5 to 3.5 per second at a pressure of from 1200 to 2500 bars and pulse duration of from 0.5 to 2.5 microseconds during 15 to 120 minutes with a subsequent immobilization for a period of from 30 to to 80 days.
5. Method for medical treatment of bone pathology according to claim 1, wherein the pathological place is subjected to the action of impact waves of from 300 to 3000 impacts with a frequency of from 1 to 3.5 per second at a pressure of from 700 to 1500 bars and pulse duration of from 1.5 to 4 microseconds during 10 to 90 minutes, with a subsequent immobilization for a period of from 15 to 60 days.
6. Method for medical treatment of bone pathology according to claim 1, wherein the pathological place is subjected to the action of impact waves of from 500 to 5000 impacts with a frequency of from 0.5 to 4 per second, at a pressure of from 850 to 1700 bars and pulse duration of from 10 to 5.5 microseconds during 15 to 95 minutes, with a subsequent immobilization for a period of from 15 to 60 days.
7. Method for medical treatment of bone pathology according to claim 1, wherein the pathological place is subjected to the action of impact waves of from 1000 to 5500 impacts with a frequency of from 1 to 4 per second, at a pressure of from 950 to 1900 bars a pulse duration of from 0.5 to 5.5 microseconds during 20 to 110 minutes, witn a subsequent immobilizatlon for a period of from 15 to 90 days.
8. Method for medical treatment of bone patnology according to claim 1 , wherein the pathological place is subjected to the action of impact waves of from 350 to 4000 impacts with a frequency of from 1 to 2.5 per second at a pressure of from 750 to 1600 bars and pulse duration of from 1.5 to 3 microseconds during 10 to 105 minutes, with a subsequent immobilization for a period of from 15 to 30 days.
9. Method for medical treatment of bone pathology according to to claims 2, 3, 4 and 5, wherein the impact waves acting on the pathological place are electronydraulic.
10. Apparatus for medical treatment of bone pathology comprising a generator or impact waves with a housing shaped as a vessel containing an acoustic liquid, covering the discharger disposed in its bottem end, and its upper end is provided with a flexible membrane, while over the generator of impact waves there is disposed the patient carriage, w h e r e i n inside the outer housing (1) there is disposed a generator of impact waves (2), to the base of which there are fastened guiding rolls (3), which are in contact with the internal surface (4) of the outer housing (1), opposite to which there is disposed a x-ray generator (5), the longitudinal axis (13) of which coincides with the longitudinal axis (13) of the television camera (12), and their point of intersection with the longitudinal axis of the light diaphragm (10), disposed beforethe electronic optical converter (11), form the point of action
(15), and to the outer housing (1), behind the television camera (2), there is positioned a protective barrier (16).
11. Apparatus for medical treatment of bone pathology according to claim 10, wherein the generator of impact waves (2) is rigidly connected to the central part of a carrying arm (24), which can rotate around its axis (14), and is connected to the outer housing (1).
12. Apparatus for medical treatment of bone pathology according to claim 10, wherein the generator of impact waves (2) is electrohydraulic.
PCT/BG1988/000001 1987-05-19 1988-05-18 Method and apparatus for medical treatment of the pathological state of bones Ceased WO1988009190A1 (en)

Priority Applications (8)

Application Number Priority Date Filing Date Title
KR1019890700102A KR890701167A (en) 1987-05-19 1988-05-18 Medical Method and Device for Bone Treatment
BR888807063A BR8807063A (en) 1987-05-19 1988-05-18 PROCESS AND APPLIANCE FOR MEDICAL TREATMENT OF THE BONE PATHOLOGICAL STATE
KR1019890700102A KR930001306B1 (en) 1987-05-19 1988-05-18 Method and apparatus for medical treatment of the pathological state of bones
HU883920A HU203483B (en) 1987-05-19 1988-05-18 Apparatus for medical treating pathological bone diseases
NO890224A NO890224D0 (en) 1987-05-19 1989-01-18 PROCEDURE AND DEVICE FOR MEDICAL TREATMENT OF THE PATHOLOGICAL CONDITION OF BONE.
FI890262A FI890262A0 (en) 1987-05-19 1989-01-18 FOERFARANDE OCH APPARAT FOER MEDICINISK BEHANDLING AV PATOLOGISKA TILLSTAONDET I BEN.
DK022489A DK22489A (en) 1987-05-19 1989-01-19 METHOD AND APPARATUS FOR MEDICAL TREATMENT OF THE PATHOLOGICAL CONDITION OF BONE
SU894614504A RU1836056C (en) 1987-05-19 1989-07-12 Method of treatment for patients with osteopathy

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BG79804 1987-05-19
BG79804A BG46024A1 (en) 1987-05-19 1987-05-19 Method and device for treatment of bone patology

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NO890224L (en) 1989-01-18
FI890262A7 (en) 1989-01-18
EP0314771A1 (en) 1989-05-10
AU612671B2 (en) 1991-07-18
US4979501A (en) 1990-12-25
DK22489A (en) 1989-03-07
BR8807063A (en) 1989-10-31
HUT50446A (en) 1990-02-28
NO890224D0 (en) 1989-01-18
RU1836056C (en) 1993-08-23
HU203483B (en) 1991-08-28
DK22489D0 (en) 1989-01-19
BG46024A1 (en) 1989-10-16
JPH02501038A (en) 1990-04-12
JP2661737B2 (en) 1997-10-08
CA1330580C (en) 1994-07-05
KR890701167A (en) 1989-12-19
AU1938088A (en) 1988-12-21
KR930001306B1 (en) 1993-02-25
FI890262A0 (en) 1989-01-18

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