METHOD AND APPARATUS FOR MEDICAL TREATMENT OF THE PATHOLOGICAL STATE OF BONES

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 med treatment of hone pathology which finds application in orthopa tr umatologic practice for medical treatment of pseudoarthrosi delayed consolidation, hone de ormations, correction of the le of long tubular hones, performing art rodesis , acceleration of normal bone knit, treatment of bone tumours, aseptic necrosis, delay of the bone growt L.epiplaysiodesis) , a.o. In a known method for medical treatment of pseudoarth.rosis, layed consolidation and bone deformations, after anesthesis the skin of the limb in the place of injury is cleaned as for opera 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 quently there occur complications, such as suppurations, osteom litis, ϊhere are not provided proper conditions for consolidatio and, therefore, the method is not sufficiently effective. Another known operative method for medical treatment consists that, after anesthesis of the limb, the latter is fixed to the o ration table, there is performed by operation a penetration to bone, the periosteum is opened and the adges of the injured bone ends are scraped, while in case of bone deformations a bone tri is cut out. A proper or preserved bone transplantate is put in place. he fragments ire aligned and are osteosynthesized with ferent materials. he periosteum and the soft tissues are resto and finally there is effected an external immobilization for a riod of from 60 to 180 days C2). The drawbacks of this method lie in that it is invasive with post-operation complications possible to occur. There is require a prolonged stay in hospital. After the healing of the injury, there is necessary a second operation for the removal of the os sythesizing materials. In some cases there are necessary severa operative interventions in the event of recidive. known apparatus for the fragmentation of kidney stones, th 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 v/aves, over which there is disp the patient carriage, underneath which there is fastened the he of an ultrasonic emitter, the vertical axis of which coincides the vertical axis of the generator of impact v/aves and passes the zone of fragmentation of the kidney stones. he generator pact waves consists of a housing, shaped as a vessel containin acoustic liquid, in the bottom end of which there is disposed charger which is covered by the liquid contained in the housin and in its top end there is provided a flexible membrane (,3)« The drawback of this device lie in that in cannot be used f medical treatment of bone pathology. It is therefore a general object of this invention to devel method for medical treatment of bone pathology which is non-op tive, extracorporal, ambulatory, and can shorten the duration the recovery process. It is another object of this invention to develop an appara for the treatment of bone patholcgy which -is of compact design makes possible a quick and painl,. 's carrying out of the treatm xhe object is achieved by a method for medical treatment of pathology in which, after anesthesis, the limb is fixed to the carrying carriage of the apparatus and is finally immobilized. cording to the invention, after the fixation of the limb and t centering of the pathological place and before the immobilizati it is subjected once, consecutively and extracorporally to the . tion of 300 to 6000 impact waves with a frequency of 0.5 to 4 p second, at a pressure in the focus of from 700 to 2500 bars, at pulse duration of from 0 5 to 4 microseconds during 10 to 120 m nutes, with a subsequent immobilization fro 15 to 90 days. The object is also achieved by a method for medical treatmen of bone pathology, pseudoarthrosis, delayed consolidation and b deformations, in which the action on the pathological place is' fected by impact v/aves of from 1000 to 5ooo impacts with a freq of 1 to 2 per second, at a pressure of from 1200 to 2CC0 bars a pulse duration of from 1.5 to 3 microseconds during 20 to 110 mi nutes, with a subsequent immobilization of from 40 to 90 days. The object is also achieved by another method for medical tr ment of bone pathology for the correction of the length of long bular bones, in which a device for extrafocal fixation is place the bone and the pathological place is subjected to the action impact waves of from 1000 to 6000 impacts with a frequency of 1 3 per second, at a pressure of from 1100 to 1700 bars and a pul duration of from 1 to 3.5 microseconds during 30 to 115 minutes subsequent immobilization of from 60 to 85 days. The object is also achieved by a method for medical treatmen of bone pathology for extracorporal performance of arthrodesls, which the pathological place is subjected t . the action of impa waves of from 750 to 6000 impacts with a fr quency of from 0.5 3.5 per second, at a pressure of from 1200 : * 2500 bars and pul duration of from 0.5 to 2.5 microseconds during 15 to 120 minu and subsequent Immobilization of from 30 to SO days. The object is also achieved by a method for medical treatmen bone pathology for acceleration of the normal bone knit, in whi the pathological place is subjected to the action of impact wav of from 300 to 3000 impacts, with a frequency of from 1 to 3.5 second at a pressure of from 700 to 1500 bars and a pulse durat of from 1.5 to 4 microseconds during 10 to 90 minutes, and subs quent immobilization of from 15 to 60 days. The object is also achieved by a method for medical treatmen bone pathology in case of bone tumours, in which the pathologic 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. t; ~ . ~ microseconds during 13 to 95 minutes, a ά subsequent im lisation of from 15 to 60 days. The object is also achieved by a method for medical treatme bone pathology in case of delay of the bone growth (.epiphysiod in which the pathological place is subjected to the action of waves of from 1000 to 5500 impacts with a frequency of from 1 per second at a pressure of from 950 to 1 00 bars and a pulse tion of from 0.5 to 3.5 microseconds during 20 to 110 minutes, subsequent immobilization of from 15 to 90 days. The object is also achieved by a method of medical treatmen bone pathology in case of aseptic necrosis, in which the patho al place is subjected to the action of impact waves of from 35 4000 impacts with a frequency of from 1 to 2.5 per second at a pressure of from 750 to 16oo bars and a pulse duration of from to 3 microseconds during 10 to 105 minutes,and subsequent immo zation of from 1 to 30 days. The object is also achieved by an apparatus which comprises housing, inside which there is disposed a generator of impact to the base: of wlαich there are fastened guiding rolls v/hich a contact with the internal surface of the outer housing, opposi which there is disposed a x-ray generator. The top end of the rator of impact waves is shaped as a vessel containing a trans ting medium, which is an acoustic liquid, and it covers the dis charger fastened to the bottom of the vessel, while in its top there is disposed a flexible membrane. Over the generator of im waves there is disposed a light diaphragm, and over it there is disposed an electronic optical converter, which is connected to television camera, the longitudinal axis of v/hich coincides wit the longitudinal axis of the x-ray generator, and its point of tersection with the longitudinal axis of the light diaphragm fo the point of action. To the outer housing, behind tha televisio mera, tnere is positioned a protective orrrier. The object is also achieved ^ ~ zι ~ ι αppcrr-tus in which t-ie gen tor of impact waves is rigidly connected to τhe centralroart of aarrying a m^ which can rotate around its axis and is connected to the external housing. Th§ .advantages of the invention lie In that the medical trea ment is non-operative, extra-co poral, ambulatory and more harm for the health of the patient. The danger of complications is r duced to minimum. The duration of treatment is reduced, too. ϊh 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 illustra and explained a preferred embodimant of the invention. In the drawings: FLg.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. is a general view of s radius bone with pseudoarthrosi Fig.5 shows how a radius bone with pseudoarthrosis is subjec 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 t action and correction; Fig.10 is " a general view of the bone after knit; Fig.11 shows a pathologically shortened radius bone place the apparatus for extrafocal fixation: Fig.12 shows the bone placed in the apparatus with diagram illustration of the arrangement for action; Fig.13 shows the process of correction of the length of a bone according to Fig.12; Fig.14 shows the bone illustrated in Fig.13 - elongated an in normal state. The apparatus for medical treatment of bone pathology comp an outer housing 1, inside which there are disposed a generat impact waves, to the base of which there are fastened guiding 3 which are in contact with the internal surface 4 of the out housing 1, opposite to which there is disposed a x-ray genera The top end cf the generator of impact waves 2 is shaped as a sel 6 which contains a transmitting medium, which is an acous liquid 7 - , ;er in this case, and it covers the high-voltage trode 8 fastened to the bottom of the vessel β, while in its end there is disposed a flexible membrane 24. Over the genera of impact waves 2 there is disposed a patient carriage 9, opp to which and over the generator of impact waves 2 there is di a light diaphragm 10, and over it there is disposed an electr optical converter 11, to which thete is connected a televisio mera 12. the longitudinal axis 13 of which coincides with the gitudinal axis of the x-ray generator 5, and its point of int ion with the longitudinal axis 14 of the light diaphragm 10 . f the point of action 15. To the outer housing 1, behind the te sion camera 12, there is positioned a protective barrier 16. apparatus is connected to a block circuit which consists of a supply block 17, the output of which is connected to the bloc 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 so connected to the television block 19, while the latter, for i part, is connected to the monitor 20, the television camera 12 the block of the electronic optical converter 21 which, for its part, is connected is connected via its output to the block of t x-ray system 22, which is connected to the input of the x-ray nerator 5. The supply block 17 is directly connected to the bloc of the high-voltage generator 23 of the generator of impact wave 2, which are interconnected. The television block 19, the block the electronic optical converter 21 and the x-ray block 22 are vided with feedforwards and feedbacks. The is also explained by means * of another pre erred embodime of the apparatus for me Lcal treatment of bone pathology, which sists of an.outer housiig 1, to which there fastened movably in one end a carrying arm . -, while to Its other end there is atta the generator of electrohydraulic waves 2. Between the electroh draulic generator 2 and the outer housing 1 there is fastened ri gidly 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 top end there is fastened rigidly the electronic optical conver 11, to which the television camera 12 is fastened rigidly. The rying arm 14 can rotate around its own axis at £ 30°. i'o the ge rator of electrohydraulic waves 2 there is fastened rigidly a v for the transmitting medium 6, which contains an acoustic liqui - in this case water, and it covers the high-voltage electrode which is fastened to the bottom of the vessel 6 for the transmi ting medium, and in its top end there is fastened a flexible me brane 24. Opposite to the generator of electrohydraulic waves 2 there is disposed the carriage for centering the patient 9, ont v/hich the patient is lying with the point of action 15. To the housing 1 there is fastened rigidly a protective barrier 16. • rhe apparatus is connected to a block circuit, which consis a supply block 17, the output of which is connected to the blo for centering the patient 18, while its output is connected to carriage with the object 9. The output of the supply block 17 connected to the television block 19 which, for its part, is c nected to the monitor 20, the television camera 12 and the blo the electronic optical converter 21 , which, is connected with i output to the block of the x-ray system 22, which is connected the input of the x-ray generator 5. The supply. lock 17" is dire connected to the block of the high-voltage generator 23, which connected to the generator of electrohydraulic waves 2.ϊhe Re block 19, the electronic optical converter 21 and the x-ray sys 22 are provided with feedforwards a _d feedbacks. The invention is also explained __y means of the following ex les of medical treatment of bone pathology: E_j__J-!PLE 1. Fig. shows a pseudoarthrosis or delayed consolid of a radius bone with bottom edge 26 and upper edge 27. A regio intravenous anesthesis of the limb with non-healed radius bone paerfor ed, and the latter is fixed to the patient carriage 9 s in Fig.1, being in contact with the flexible membrane 24 as sho in Figures 1 and 5. After the positioning of the point of actio there are delivered on the bone edge 26 1200 electrohydraulic i pacts with frequency 2 impacts per second at a pressure of 1300 bars and a pulse duration of 3 microseconds during 20 minutes. same actions are also applied to the upper bone edge 27. Fig. shows the result of the action of the electrohydraulic impact w with formation of bone sand admixed with blood coming from opened microvessels 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 tαe patient carriage 9 and there follows an external Immobilization for 80 days. EXAMPLE 2. Fig.7 shows the deformation of a radius bone 28.A performing a regional intravenous anesthesis of the limb with de formed radius bone, the latter is fixed to the patient carriage shown in Fig.1 , being In contact with the flexible membrane 24 a shown in Figures 1 and 8. After positioning, the point of action is set up on the bone deformation 28. There are delivered 3000 e trohydraulic impacts with a frequency of 2 impacts per second at pressure of 1500 bars and pulse duration of 3 microseconds durin 5o minutes. Fig. shows the result of the action of the electroh draulic impact waves with formation of fracture of the deformati 29 at preserved periosteum 30 ~~-& subsequent manual correction o the deformation. After the termination of the procedure, there i carried out an external immobilization of the limb of the patien which he must bear for 90 days. Fig.10 shows the result with kni straight position deformation of the radius bone 28. EXAMPLE 3. Fig.11 shows a shortened tubular bone 31 mounted o an apparatus for extrafocal fixation 32, and before its mountin there is performed a regional intravenous anesthesis for upper l or peridural anesthesis for bottom limb. The limb is fixed to t patient carriage 9 shown in Fig.1 where it comes in contact wit the flexible membrane 24 shown in Fig. 2. After positioning, the point of action 15 is set up on the tubular bone 31 subsequent in three spots , the distance between them being up to 20 mm, a in each spot there are delivered 1000 electrohydraulic impacts the upper limb and 1900 electrohydraulic impacts for the bottom limb.Fig.12 shows the result of the action in obtaining a fract 33 of bone 31 at preserving the periosteum 3Θ. Fig.13 shows the elongation of the bone 3 , consisting of two parts 54 and 35 a a fracture, which are extended by means of the apparatus 32 dai during 20 days until reaching the length of the sound limb. Be 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 ac After the elapsing of the 20 days, the apparatus with the elon bone remains for immobilization until the total consolidation f 4 months; the healed and elongated zone of the bone 37 is shown δ* 14, the length of the bone 31 being normalized. he apparatus for medical treatment of bone pathology accord to the invention operates as follows: After the switching-on of the supply block 17, a voltage is lied to the block for centering the patient 18 and, as a result the patient carriage with the object 9 is centered. Then the vo is supplied to the x-ray block 22 which actuates the x-rεy gene tor 5. i e rays produced by the x-ray generator 5 are pre agate along its longitudinal axis 13, they pass through the point of tion 15 and reach the electronic optical converter 11 , in the o put of which there is obtained the image of action 15. The imag is received by the television camera 12, the signal of which is transmitted to the television block 19, where it is processed a then transmitted to the monitor 20 and via the feedbacks to the block of the electronic optical converter 21 and the block of t television system 22. .he voltage supplied by the supply block passes through the block of the high-voltage generator 23 for t supply of the generator of impact waves 2. After entering a com mand in the block of the hig -voltage generator 23 hy electrode the generator of impact waves 2 begins to generate impact waves which via the acoustic medium 7 get into the point of action 15 the object 9. ..his cycle is repeated until the necessary healin effect is achieved. In a second modification of the apparatus, after switchin -on the supply block 17, there is supplied a voltage to the block fo centering the patient 18 and, as a result, the patient carriage with the object 9 is centered, xhen a voltage is supplied to the x-ray system 22 which actuates the generator of x-rays 5- -che r produced by the x-ray generator 5 are propagated along its longi dinal axis 13. i~r rotation of the carrying arm 24 around its axi 14 there is achieved a rotation of the longitudinal axis 13 at £ degrees with respect to the axis 14, which is an axis of the gen rator of impact waves, thus achieving an accurate determination the spot of action 15. Passing through the point of action 15, t rays reach the electronic optical converter 11, at the output of which there is obtained the image of the object of action 15. T image is received by the television camera 12, the signal of whi is tr -ns itted to the television block 19, where it is processe 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. __he voltage supplied by the supply block 17 pas through the block of the high-voltage generator 23 for supplyin generator of impact waves 2. -after entering a command in the blo of the high-voltage generator 23 by electrode 8, the generator o impact waves 2 begins to generate Impact waves, which via the acoustic medium 7 get into the point of action 15 of the object his cycle is repeated until the necessary healing effect is ac The impact waves can also be produced by an ultrasonic gener of impact waves, a magnetostriction generator of impact waves o a microexplosive generator of impact waves. The scope of the invention is not limited only for the afore tioned generator types, it should be understood that there can be used other generators which can generate impact waves and ca used for medical treatment of bone pathology. Cited literature: 1. ϋffenbach-Beck. Cited in: I . Koptchev , --".Erawmatologya na oporno-dviga elnya aparat", Sofia, Mβdizina i Fizkoultoura, 1976, p.137. 2. R.Watson-Jont. , -Fractures and Joint Injuries", vol. I, 1976, pp.22-50. 3. USA Patent No. 4610249.

Claims: C I M S : 1. method for medical treatment of bone pathology in which t is first performed an anesthesis, then the limb is fixed and fi immobilized, h e r e i n after the fixation of the limb, t pathologic place is centered and, before the immobilization, it subjected once, consecutively and extracorporally at least in o 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 pr sure of from 700 to 2500 bars and a pulse duration of from 0.5 4 microseconds during 10 to 120 minutes, witn a subsequent immo lization for a β ri β l of from 15 t0 90 days> 2. Method for medical treatment of bone pathology according claim 1 , wherein the action on the pathological place is effect by impact waves of-from 1000 to 5Θ00 impacts with a frequency o from 1 to 2 per second at \ pressure of from 1200 to 2000 bars, pulse duration of from 1.5 to 3 microseconds during 20 to 110 m nutes, with a subsequent immobilizatlonfor a period of from 40 90 days. 3. Method for the medical treatment of bone pathology accord to claim 1 , wherein the bone is fixed with an extrafocal fixato and the pathological place is subjected to the action of impact waves of from 1000 to 6000 impacts with a frequency of from 1 t per second at a pressure of from 11oo to 17oo bars and pulse du ration of from 1 to 3.5 microseconds during 30 to 115 minutes w a subsequent immobilization for a period of from 60 to 85 days. 4-. Method for medical treatment of bone pathology according claim 1 , wnerein the pathological place is sub ected to the act of impact waves of from 750 to 6000 impacts with a frequency of from O.D to 3.5 per second at a pressure of from 1200 to 2500 b and pulse duration of from 0.5 to 2.5 microseconds during 15 to minutes wi h a subsequent immobilization for a period of from 3 to 80 days. 5. nethod for medical treatment of bone pathology according claim 1 , wherein the pathological place is sub ected to the act of impact waves of from 300 to 3000 impacts with a frequency of 1 to 3.5 per second at a pressure of from 700 τo 15oo bars and duration of from 1.5 to 4 microseconds during 10 τo 90 minutes, a subsequent immobilization for a period of from 15 to 60 days. 6. method for medical treatment of bone pathology according claim 1, wherein the pathological place is subjected to the act 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 bar and pulse duration of from 1 to ~. o microseconds during 15 to minutes, with a subsequent immobilizat .on for a period of from 1 to 60 days. 7. i'iethod for medical treatment of bone pathology according t claim 1 , wherein the pathological place is subjected to the acti of impact waves of from 1000 to 5500 impacts witn a frequency o from 1 τo 4 per second, at a pressure of from 9 * ^0 to 1900 bars a pulse duration of from O τo u.ϊ ** microseconds during 20 τo 110 nutes, witn a subsequenτ immo ilizaτlon for a period of from 15 90 days. b. 4_iet._-.0d for medical treatment of bone pa nology according & claim 1 , wherein tne pathological place is subjected to the acti of impact waves of from 350 to 4000 impacts with a frequency of from 1 τo 2.5 per second at a pressure of from 750 τo 1600 bars and pulse duration of from 1.5 to 3 microseconds during * 10 to 10 lnuτes, w th a subsequent immobilization for a period of from 1 to 30 days. 9. meτhod for medical τreatment of bone pathology according τo claims 2, ._>, 4 and 5, wherein τne impact waves acting on ne ϋaological place are electronydraulic. 10. Apparatus for medical τreatment of bone patnology compri a generator or impact waves with a housing shaped as a vessel c taining an aoousτic liquid, covering the discharger disposed in boττπn end, and Its upper end is provided wixh a flexible membra while over τhe generaτor of impact waves nejL-e is disposed the patient carriage, h e e i n inside the ouτer housing \.1) there is disposed a generator of impact waves "(2), to the base wr ch there are fastened guiding rolls (3), which are in contac wiτn the internal surface v4) βf trie outer Housing 1 , opposi to wnicn cnere is disposed a x-ray generaτor (__>) » t.e longitudi axis 13) of wnich coincides with the longxtudin 1 axis 13) of τne television camera 12 / , and τnelr point of intersection wit tne longitudinal axis of the lrgnt diapnragm x 10,, disposed bef -fcjae electronxc optical converter (ϊl;, fo__.m. the point of acτion (15 ), and to the outer housing (1), benind the television camer (2), tnere is posiτioned a protective barrier (16). 11. Apparatus for medical treatment of done pathology accord τo claim 10, ** nerein τne generator of iia.p.Cu waves ^2 is rigid co_unected to th central par v. of a carrying a m. v 24/, wuich cau rotate around its axis (14), and is connected to tu outer ixou 12. Apparatus for medical treatment of bone pathology accord to clar 10, wnerem the generator of impact waves 2) is elect nydraulic.

Inventors: KERIN TODOR PETKOV, MANOLOV STOYAN SLAVCHEV, MIHAYLOV PETER MARINOV, PATRASHKOV TODOR KRESTEV, VALCHANOV VYACHESLAV DEYANOV, KERIN, TODOR, PETKOV, MANOLOV, STOYAN, SLAVCHEV, MIHAYLOV, PETER, MARINOV, PATRASHKOV, TODOR, KRESTEV, VALCHANOV, VYACHESLAV, DEYANOV
Applicants: VISSH VOENNOMEDICINSKI INST, VISSH VOENNOMEDICINSKI INSTITUT
Application year: 1988
Main classification: A61N1
IPC codes: A61B17, A61H23, A61N7