Makolinets K. Justification diagnosis and conservative treatment of early gonarthrosis (experimental and clinical research)

Object: experimentally modeled gonarthosis in rats, gonarthrosis in patients with early-stage disease. Aim: increase the therapy efficiency of patients with early stages of gonarthrosis on basis of improvement of methods diagnosis and complex conservative treatment. Methods: clinical, radiographic, biochemical, sonographic, morphological, electron microscopy, statistics. For the first time in experimental studies it was proved that using in conservative treatment of animals with modeled gonarthrosis of complex "laser - diclofenac sodium - glucosamine hydrochloride" to lead to the most complete restoration of quantitive and structural-metabolic status of chondrocytes of articular cartilage and activation of its biosynthetic processes. In the cartilage matrix the normalization of orientational ordering of glycosaminoglycans and their contents was marked. New knowledge about the features of metabolic disorders glycoproteins and glycosaminoglycans in patients with early gonarthrosis was received. The metabolic disorders of connective tissue in patients with I-II stage of gonarthrosis on the basis of biochemical markers - glycoproteins, sialic acid, chondroitin sulfate, the fractions of GAGs, alkaline phosphatase activity and its bone isoenzyme, fibronectin and hyaluronidase were shown. The most diagnostically sensitive biochemical markers of connective tissue metabolism in gonarthrosis were identified. The correlation between their size and stage of process has been established. According to our method the diagnostic criteria of sonographic study of the joints for evaluate of the degree of inflammatory and degenerative disorders of the joints in patients with early stages of gonarthrosis, before and after treatment were determined. On the basis of ultrasound examination the characteristics of structural changes in the knee joints of patients with I-II stage of gonarthrosis were identified. For the first time it was proved that the use in complex conservative treatment of laser therapy, diclofenac sodium and glucosamine hydrochloride in the indicated sequence significantly improves the results of treatment of patients with early stages of gonarthrosis. The results of studies introduced into clinical practice of SI "Sytenkо Institute of Spine and Joints Pathology National Academy of Medical Sciences of Ukraine", SI " Sanatorium and resort Rehabilitation Centre "Slavyanskiy kurort", SI "Specialized (special) Clinical Sanatorium "Orlenok" Ministry of Health of Ukraine" and in the educational process of the Department of Traumatology and Orthopedics of Kharkiv Medical Academy of Postgraduate Education Ministry of Health of Ukraine, the Department of Physical Rehabilitation and Sports Medicine with a course of physical education and health of Kharkiv National Medical University, the Ministry of Health of Ukraine. Traumatology and Orthopedics.