Журнал «Травма» Том 15, №4, 2014

The work is dedicated to a problem of raising the efficiency of sanatorium rehabilitation of the patients with traumatic illness of spinal cord (TISC ). Objective: to study the influence of complex sanatorium treatment with the use of mud cure of various areas on the structural-functional state and bone metabolism in patients with TISC.

Material and methods. The study involved 88 males patients with TISC aged from 22 to 43 years, treated in a specialized spinal sanatorium named after academician N.N. Burdenko. Disease duration ranged from 1 year to 12 years. Spinal cord lesion at the level of the thoracic spine was in 24 (27,3 %) patients, lumbar - in 64 (72,7 %) patients. Structural-functional state of bone tissue was studied using ultrasound densitometry by the apparatus «Achilles+» (Lunar Corp. Madison, USA) with measurement of: Speed of Sound (SOS, m/s), Broadband Ultrasound Attenuation (BUA, dB/MHz), the index of bone strength - (Stiffness - STF, %).

We investigated the levels of calcium regulating hormones in the blood serum (parathyroid hormon, calcitonin, calcitriol), bone metabolism markers (alkaline phosphatase activity and osteocalcin in blood serum, with a ratio of desoxypyridinoline in urine creatinine (DPD/Cr).

Duration of treatment was 40 days. Depending on the treatment patients with TISC (n = 88) were divided into 2 groups, representative for age, clinical characteristics and structural-functional state of bone tissue (according to ultrasound densitometry data). Both groups held conventional for this category of patients treatment, which included a complete balanced diet, climatic treatment, gymnastics, mechanic therapy, massage, rectal mud tampons, physiotherapy, psychotherapy. All patients received calcemin (Sagmel, Inc., USA). In group I (n = 52) mud cure in the form of applications of sulphide silt mud of a large area, more than 50 % of body surface («pants» and spine), was additionally applied. In group II (n = 36) applications of sulphide silt mud of small area were applied in a complex treatment, in the form of «pants» and tape along the spine. Both groups used mud rectal tampons.

Results and discussion. Applying of ultrasound densitometry in patients with TISC revealed a decrease of STF from (-1 SD) to (-2,5 SD) in 51 (57,9 %) patients, reduced STF more than 2,5 SD – in 26 ( 29,5 % ) patients. 11 (12,5 %) patients were within normative values of structural-functional indicators of bone state.

As a result of treatment of patients in group I showed a decrease of indicators of SOS (from 1538,39 ± 3,85 m/s to 1534,54 ± 4,02 m/s; p < 0,001), BUA (from 98,33 ± 1,81 dB/MHz to 95,35 ± 1,89 dB/MHz; p < 0,001), which resulted in a significant decrease of STF from 76,21 ± 1,84 % to 73,13 ± 2,02 % (p < 0,001) and was 4,04 % of initial values. This occurred against the background of increasing levels of parathyroid hormone (p < 0,01) reduction of calcitonin (p < 0,01) without significant dynamics of the content of calcitriol, as well - to the rising marks of DPD/Cr in urine by 29,3 % (p < 0,001) and reduction in osteocalcin content (p < 0,05) in blood serum. The most pronounced negative dynamics of the studied parameters in group I was observed in patients with initial osteopenia and osteoporosis. In patients in group II after spa treatment an increase of SOS parameter was observed (from 1536,94 ± 4,85 m/s to 1538,69 ± 4,55 m/s; p < 0,05) without significant BUA dynamics (from 99,17 ± 2,05 to 99,50 ± 2,01 dB/MHz), as a result STF after treatment did not change significantly (before treatment 76,37 ± 2,39 %, after treatment 77,08 ± 2,29 %). This happened against the background of calcitonin content increase (p < 0,05), increase in alkaline phosphatase activity (p < 0,05), reduction of DPD/Cr in urine at 7,13 %, pointing out to intensification of bone formation and decrease in bone resorption.

These obtained results correspond with literature data (H.V. Karepov, 1995) and, in our opinion, caused by the exhaustion of the body's adaptive capabilities in applying mud applications of a large area. This indicates the need for strict dosing of mud applications and accounting the measure of breach of structural-functional state of bone tissue in the prescribing of the complex spa treatment of patients with TISC.

Conclusions. Application of mud applications of a large area, more than 50 % of body surface, in patients with TISC is accompanied by progression of violations of structural-functional state of bone tissue, more expressed in osteopenia and osteoporosis, by a significant decrease in bone strength index and the negative dynamics of indicators of bone metabolism, that testifies to slowing the processes of formation and activation of bone resorption. Complex spa treatment of the patients with TISC with use of a small area mud applications helps to activate the processes of bone formation and normalization of its resorption.