close

Вход

Забыли?

вход по аккаунту

?

Альтернативные методы лечения заболеваний суставов доктор Uwe heidbrink

код для вставкиСкачать
Материалы симпозиума "Методы регенеративной медицины в травматологии и ортопедии лошадей". НОИР. 25.02.2012.
St. Petersburg, 2012 Heidbrink, U.H.
Alternative methods for joint treatment
Uwe H. Heidbrink
Dr. med. vet., MRCVS
Fachtierarzt für Chirurgie •Fachtierarzt für Pferde
Pferdeklinik am Kirchberg
Piesenkamer Strasse 18 •D –83607 Holzkirchen
St. Petersburg, 2012 Heidbrink, U.H.
Pferdeklinik am Kirchberg
St. Petersburg, 2012 Heidbrink, U.H.
Joint inflammation in horses
lameness has been shown to be the major cause of loss (68 %) of horses from the racing industry in England
40 -50 % of horses admitted to the hospital for lameness have lameness due to or associated with joint problems
-correct medical and/or surgical therapy should consider all structures involved in the joint function
-because of limitations in the repair of joint tissues the prognostication of the longterm outcome of joint diseases is difficult
St. Petersburg, 2012 Heidbrink, U.H.
Clinical manifestation of joint disease
effusion
•imbalance between production and removal of synovial fluid
•increased production during synovitis
pain
•exhibited as lameness or a positive response to a flexion test
-decreased range of motion
•related to pain, effusion, capsular fibrosis
•edema, hypertrophy and hyperplasia of the synovial membrane
St. Petersburg, 2012 Heidbrink, U.H.
Clinical manifestation of joint disease
-synovial fluid aberation
•reduced synovial fluid viscosity due to depolimerization of hyaluronan
-articular cartilage degeneration
•primary event in the pathogenesis of osteoarthritis, which is finally characterized by total loss of cartilage, sclerosis and focal osteonecrosis
St. Petersburg, 2012 Heidbrink, U.H.
Aims of joint treatment
-reducing joint pain -decreasing joint inflammation
-protecting the cartilage from further injury (chondroprotection)
St. Petersburg, 2012 Heidbrink, U.H.
„Classic“principles of joint therapy
rest
-nonsteroidal anti-inflammatory drugs (NSAIDs)
•phenylbutazone 2-4 g/day/500kgBW i.v./oral
•flunixin-meglumine 1,1 mg/kgBW SID i.v.
•meloxicam 0,6 mg/kgBW SID i.v./oral
corticosteroids (systemic or intraarticular) •dexamethasone
•methylprednisolone
•betamethasone
•triamcinolone acetonide
St. Petersburg, 2012 Heidbrink, U.H.
„Classic“principles of joint therapy
polysulfated Glycosaminoglycan (PSGAG)
-Hyaluronic acid (HA) 20-50 mg/joint
40-50 mg i.v.
-Arthroscopy
•removal of OCD fragments
•debridement of traumatic or degenerative cartilaginous flaps
•Synovectomy
St. Petersburg, 2012 Heidbrink, U.H.
Osteoarthritis
Intertarsal joint
St. Petersburg, 2012 Heidbrink, U.H.
Cystic lesion
Coffin bone
St. Petersburg, 2012 Heidbrink, U.H.
Cystic lesion
Navicular bone
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
ARTHRAMID
®
Gel
•polyacrylamide Hydrogel (PAAG)
•Integration into the synovial membrane
•works as a buffer •2 ml/joint
•effect 2-3 weeks after injection for minimum 12 months St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
ARTHRAMID
®
Gel
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Fetlock joint with a small fissure St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Fetlock joint with a small fissure St. Petersburg, 2012 Heidbrink, U.H.
Therapy:
2 ml Arthramid
Infusion with Biphosphonates 5 days box rest
15 minutes walk for 4 weeks
Outcome:
2 months after therapy without lameness
Alternative joint therapy
Fetlock joint with a small fissure St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Radiosynoviorthesis (RSO) / radiation synovectomy
= regeneration (Orthesis) of the synovial membran (Synovialis) -local application of a radioactice substance produces a synovectomy to reduce the inflammation in the joint
-alternative to a surgical synovectomy during an arthroscopic surgery
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Radiosynoviorthese (RSO)
•xray´s
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Radiosynoviorthese (RSO)
•arthroscopic findings
increased blood supply in an acute inflammation
Normal synovial membranethickening of the villi in case of a severe inflammation St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Radiosynoviorthese (RSO)
•used Radiopharmaceutical
Yttrium-90 (
90
Y) -radioactive half-life 2,7 days
-Beta emitter
-range in tissue max. 11 mm (mean 3,6 mm)
Rhenium-186 (
186
Re)
-radioactive half-life 3,7 days
-Beta-and Gamma emitter
-range in tissue max. 3,7 mm (mean 1,2 mm)
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Radiosynoviorthese (RSO)
Indications
-chronic joint inflammation
-recurrent joint effusion
-activated Arthrosis
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Radiosynoviorthese (RSO)
side-effect
-occasionally painful inflammatory reactions in the treated joint
-seldom tissue necrosis due to non-intraarticular injection
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Radiosynoviorthese (RSO)
Treatment (1)
-Correct puncture of the affected joint
-Positioning of the needle in the joint
because injection into the surrounding tissue would cause massive necrosis
-aspiration of excess joint fluid
-Application of the radiopharmacon in combination with a corticosteroid to reduce the danger of a radiation induced inflammation
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Radiosynoviorthese (RSO)
Treatment (2)
-apply of a firm bandage
-boxrest for 2 days
-slowly increased movement in walk by hand, later under the rider
-clinical and radiological control on a regular basis
-if necessary repeated injection after minimum 6 months
St. Petersburg, 2012 Heidbrink, U.H.
Radiosynoviorthese (RSO)
Synovial structure
186
Rhenium
90
Yttrium
coffin joint148,0 MBq111,0 MBq
pastern joint92,5 MBq
fetlock joint front185,0 MBq148,0 MBq
fetlock joint hind185,0 MBq148,0 MBq
carpus proximal 185,0 MBq148,0 MBq
carpus middle and distal185,0 MBq148,0 MBq
talocrural joint277,5 MBq240,5 MBq
distal intertarsal joint74,0 MBq
tarsometatarsal joint74,0 MBq
medial femorotibial joint 277,5 MBq240,5 MBq
femoropatellar joint370,0 MBq296,0 MBq
lateral femorotibial joint148,0 MBq111,0 MBq
common flexor tendonsheath185,0 MBq148,0 MBq
bursitis volume <10 ml92,5 MBq
11 -15 ml129,5 MBq
16 -20 ml148,0 MBq
> 20 ml296,0 MBq
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Radiosynoviorthese (RSO)
-good alternative to classical joint therapy, especially in casesof recurrent joint inflammation
-final evalution of the result earliest 6 months after injection
-the bigger the cartilage damage and the arthrotic changes in thejoint the minor are the prospects of success
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Autologous Conditioned Plasma (ACP)
-activated platelets release growth factors that induce a healingprocess wherever they are applied
-induce proliferation and differentiation of various cell types (stem cells, osteoblasts, epidermal cells)
-enhance/modulate the production of collagen and proteoglycan
-stimulate angiogenesis
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Autologous Conditioned Plasma (ACP)
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Autologous Conditioned Plasma (ACP)
Withdrawel of approximately
9 ml of venous blood
syringe sealed with the red cap
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Autologous Conditioned Plasma (ACP)
positioning in the centrifuge
1500 rpm / 5 min
the plunger of the smaller inner syringe is slowly withdrawed to
transfer the supernatant (ACP)
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Autologous Conditioned Plasma (ACP)
the small inner syringe is
unscrewed and the ACP ready for injection
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Autologous Conditioned Plasma (ACP)
•Dressage horse
•recurrent lameness
•several treatments into
the coffin joint with HA and corticosteroids
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Autologous Conditioned Serum (ACS)
•IRAP
®
Interleukin-1 Receptorantagonist
•Anti-inflammatory and chondroprotective
•relief of pain, inflammation and reduction of swelling
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Autologous Conditioned Serum (ACS)
Group 1:
•Horses with a diagnosed arthritis and no specific pathology such as Osteochondrosis (OC) or osteochondral bone fragments (OCD)
•already treated with Hyaluronic acid and/or corticosteroids with little or no improvement
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Autologous Conditioned Serum (ACS)
Group 1
•Showjumper
•recurrent lameness
•several treatments with HA and corticosteroids
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Autologous Conditioned Serum (ACS)
Group 1
•standing MRI: subchondral reactions in
the proximal P1
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Autologous Conditioned Serum (ACS)
Group 1
•standing MRI: subchondral reactions in
the coffin bone
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Autologous Conditioned Serum (ACS)
Group 2:
•Joints after an Arthroscopy with cartilage lesions but not totally destroyed cartilage
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Autologous Conditioned Serum (ACS)
Group 2
•Dressage horse
•recurrent lameness
•several treatments with HA and corticosteroids
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Autologous Conditioned Serum (ACS)
Group 2
•standing MRI: profound
edema distal metacarpus
(T2 sequence)
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Autologous Conditioned Serum (ACS)
Group 2
•standing MRI: profound
edema distal metacarpus
(STIR sequence)
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Autologous Conditioned Serum (ACS)
Group 2
•arthroscopic findings:
loss of hyaline cartilage
in the distal metacarpus
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Autologous Conditioned Serum (ACS)
Group 3:
•Joints with an acute inflammation and effusion that had no previous treatment
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Autologous Conditioned Serum (ACS)
Group 3
•Showjumper
•recurrent lameness
•history of pastern joint
treatment, 1 treatment coffin
joint with HA and corticosteroids
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Autologous Conditioned Serum (ACS)
Group 3
•standing MRI:
loss of hyaline cartilage in
the coffin joint
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Autologous Conditioned Serum (ACS)
Group 3
•standing MRI:
loss of hyaline cartilage in
the pastern joint with subchondral reactions in the distal P1
St. Petersburg, 2012 Heidbrink, U.H.
Alternative joint therapy
Autologous Conditioned Serum (ACS)
St. Petersburg, 2012 Heidbrink, U.H.
Thank you for your attention!
WWW.PFERDEKLINIK-AM-KIRCHBERG.DE
Автор
irina.turenko
Документ
Категория
Образование
Просмотров
192
Размер файла
4 272 Кб
Теги
альтернативные, заболеваний, суставов_доктор, uwe, методы, heidbrink, лечения
1/--страниц
Пожаловаться на содержимое документа