Abstract
Introduction. Low-intensity pulsed electric stimulation of the affected joints activates microcirculation and trophism, release of opioid neuropeptides into the vascular bed, which determines the use of transcutaneous electric nerve stimulation as an effective and low-cost method for the rehabilitation of occupational knee osteoarthritis. Aim. To study the state of the arteries of the lower extremities in patients with occupational knee osteoarthritis (OKO) and substantiate the use of dynamic electric nerve stimulation (DENS) for the correction of microcirculatory disorders. Materials and methods. The study included 55 men with occupational OKO (mean age 49.3 ± 3.6 years, mean work experience 22.3 ± 3.6 years) – the main group. The control group consisted of 20 apparently healthy men working in allowable job conditions. Doppler ultrasound of vessels of the lower extremities and laser Doppler flowmetry were performed. To assess the non-drug correction of microcirculatory changes, the patients of the main group were randomized into two groups: the 1st group (35 individuals) received a conventional treatment in combination with DENS for 14 days. Patients of the 2nd group (20 individuals) received only conventional therapy. Results. Doppler ultrasound for the posterior tibial arteries in patients with OKO showed an increase in the systolic-diastolic ratio by 11.48% from the baseline values, the resistivity index – by 6.9%, the pulsatility index – by 8.8%, and an increase in intima-media thickness by 1.46 times as well. In patients with OKO, a decrease in the microcirculation indicator by 1.3 times was revealed, relative to the indicators of the control group; the amplitude of vasomotor (Av) and pulsatile (Ap) oscillations – by 1.6 and 2.4 times, respectively. When performing the breath-holding and occlusion tests in patients with OKO and the control group, an increase in capillary blood flow reserve (CBFR) by 1.2 and 1.3 times, respectively, was revealed; as well as the biological zero values – by 1.4 times and a decrease in the half time of blood flow recovery – by 1.2 times. In patients after treatment with DENS, the microcirculation indicator increased by 1.2 times compared to the baseline values, the amplitudes of slow Av and Ap oscillations increased by 1.2 and 1.9 times, respectively, BFR in the breath-holding test decreased by 1.3 times, and in the occlusion test increased by 1.16 times, which was not observed in the 2nd group. Conclusion. In patients with OKO, the significant remodeling of the popliteal and posterior tibial arteries, impaired microcirculation processes with a simultaneous decrease in the vascular reactivity and congestion in venous microvessels are revealed. Optimization of the comprehensive treatment of knee osteoarthritis by low-intensity pulsed electric stimulation has a positive effect on microcirculation, contributing to an increase in tissue perfusion and a decrease in venular congestion.
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