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"code": "M51",
"name": "Поражение межпозвоночных дисков других отделов",
"icd_name": "Поражение межпозвоночных дисков других отделов",
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"age_min": 0,
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"slug": "m51_porazhenie_mezhpozvonochnyh_diskov_drugih_otdelov",
"lead": "Нарушение здоровья, относящееся к группе другие дорсопатии",
"description": "Грыжа межпозвонкового диска поясничного отдела позвоночника — выпячивание или выпадение фрагментов межпозвонкового диска поясничного отдела в позвоночный канал, возникающее в результате остеохондроза позвоночника, травмы и приводящее к сдавлению нервных структур. Грыжи дисков пояснично - крестцового отдела позвоночника — довольно распространенное явление (300 на 100 000 населения). \r\nЧаще встречается у мужчин 30–50 лет. ",
"etiology": "<p>Причинами появления грыжи в поясничном отделе чаще всего являются:</p>\r\n<ul>\r\n<li>остеохондроз;</li>\r\n<li>большие физические нагрузки, подъём тяжестей;</li>\r\n<li>резкие наклоны, повороты, падения;</li>\r\n<li>сколиози другие искривления позвоночника;</li>\r\n<li>дисплазия тазобедренного сустава;</li>\r\n<li>нарушение обмена веществ;</li>\r\n<li>травмы позвоночника, особенно после автомобильных аварий.</li>\r\n</ul>\r\n<p> </p>\r\n<p>Факторами риска для появления поясничной грыжи являются:</p>\r\n<ul>\r\n<li>лишний вес, неправильное питание;</li>\r\n<li>работа за компьютером, постоянное вождение автомобиля;</li>\r\n<li>недостаточная физическая нагрузка;</li>\r\n<li>наследственная предрасположенность;</li>\r\n<li>старение организма;</li>\r\n<li>инфекции, переохлаждение;</li>\r\n<li>курение.</li>\r\n</ul>\r\n<p> </p>",
"pathogenesis": "<p>Поясничный отдел позвоночника состоит из 5 позвонков. Они соединены между собой межпозвоночными дисками. Диски обеспечивают амортизацию позвонков, равномерно распределяют нагрузку на поясничный отдел. Каждый диск состоит из твёрдой оболочки — фиброзного кольца, внутри которого находится полужидкое ядро.</p>\r\n<p>Пульпозное ядро не сразу оказывается за пределами диска. До этого проходит несколько стадий:</p>\r\n<p>Протрузия диска. Фиброзное кольцо слегка теряет упругость, в результате пульпозное ядро смещается в одну из сторон. Если на этом этапе обеспечить правильное чередование отдыха и лечебных упражнений, процесс межпозвоночного грыжеобразования можно остановить. Неполное выпадение участка диска. Фиброзное кольцо разрушается в одном участке, и туда устремляется материал пульпозного ядра. Полный пролапс диска. Ядро выходит за пределы фиброзного кольца, сдавливая тела позвонков и структуры нервной системы. Секвестрация диска. Так называется состояние, когда участок «обретшего свободу» пульпозного ядра попадает в спинномозговой канал. Это приводит к защемлению нервных окончаний, вплоть до сдавливания спинного мозга. Без своевременного лечения болезнь может вызвать паралич ног.</p>",
"diagnostics": "<p>Диагностика грыжи на начальных этапах включает в себя неврологический осмотр, где врач-невролог проводит следующие исследования:</p>\r\n<p>определения рефлексов с сухожилий, расположенных на ногах; теста с подъемом прямой ноги; исследования температурной, болевой и вибрационной чувствительности по всей поверхности ног, в области ягодиц, промежности, нижней половины живота.</p>\r\n<p>При межпозвоночной грыже пояснично-крестцового отдела будут отмечаться чувствительные расстройства в зоне, иннервируемой пораженным корешком, невролог определит выпадение или снижение сухожильных рефлексов, выявит глубокие нарушения биомеханики движений пораженными конечностями. Неврологический осмотр помогает предварительно определить пораженный сегмент.</p>\r\n<p>Сам же диагноз ставится на основании одной из томографий – магнитно-резонансной или компьютерной мультиспиральной – пояснично-крестцового отдела. При указании на повреждение спинного мозга диагностика может дополниться контрастной миелографией – исследованием, при котором путем люмбальной пункции в спинномозговой канал будет введено контрастное для рентгена вещество. Далее выполняется рентген, на котором видно, как контрастное вещество проходит в позвоночном канале, не накапливается ли на каком-то уровне (последнее означает, что сдавлен спинной мозг).</p>\r\n<p>Электромиография позволяет дифференцировать сдавление корешка от периферической невропатии.</p>",
"treatment": "<p>Основной метод — консервативная терапия</p>\r\n<p>Консервативная терапия включает:</p>\r\n<ul>\r\n<li>Тракционное лечение (вытяжение поясничного отдела позвоночника)</li>\r\n<li>Эпидуральные блокады смесью растворов местного анестетика и глюкокортикостероида</li>\r\n<li>НПВС, анальгетики, сосудистые препараты, витаминотерапия</li>\r\n<li>Массаж, физиотерапия, акупунктура</li>\r\n<li>После купирования острой фазы — ЛФК для повышения мышечной силы.</li>\r\n</ul>\r\n<p>Оперативное лечение</p>\r\n<ul>\r\n<li>Показаниями к проведению операции является неэффективность адекватного консервативного лечения при наличии признаков стабильной компрессии корешка (особенно при появлении мышечной слабости) Неотложное хирургическое вмешательство проводится при сдавлении корешков конского хвоста.</li>\r\n</ul>\r\n<p>Суть операции – в высвобождении спинного мозга или корешков от сдавливающей их грыжи. Выполняться это может следующим образом:</p>\r\n<p>Эндоскопическим способом. В области позвоночника делается 3 микроразреза, в один вводится камера, которая будет транслировать изображение на монитор, через 2 других хирурги работают микроинструментарием. Удаляется грыжевое выпячивание и остаточные элементы пульпозного ядра. Чрескожная дискэктомия. Это вмешательство предполагает удаление через прокол в межпозвоночном диске его разрушенного ядра. Далее производят его замену особым веществом, которое, для приобретения нужных свойств, должно охладиться. Эндопротезирование диска. Поврежденный диск удаляется, на его месте ставится имплант. Лазерная реконструкция. Пульпозное ядро наиболее насыщено водой. На это и рассчитан лазер, который обладает свойством выпаривать влагосодержащие структуры.</p>",
"prevention": "<p>Для профилактики поясничной грыжи рекомендуется:</p>\r\n<ul>\r\n<li>больше ходить пешком, заниматься спортом — плаванием, йогой;</li>\r\n<li>следить за осанкой, при ходьбе держать голову и спину прямо;</li>\r\n<li>при работе за компьютером опираться на спинку стула;</li>\r\n<li>при долгом сидении делать перерывы и выполнять упражнения — например, 10 наклонов туловищем в разные стороны. При этом нужно держать руки на пояснице;</li>\r\n<li>перед тем, как поднять тяжесть, сгибать колени, держать спину прямо;</li>\r\n<li>распределять вес в обе руки;</li>\r\n<li>спать на ортопедическом матрасе;</li>\r\n<li>употреблять курятину, говядину, рыбу, молочные продукты;</li>\r\n<li>отказаться от жареных блюд, консервированных продуктов, острых приправ;</li>\r\n<li>не курить.</li>\r\n</ul>\r\n<p> </p>",
"clinical_picture": "<p>Различают следующие симптомы поясничной грыжи:</p>\r\n<ul>\r\n<li>Боль в пояснице – непостоянная, тупого, ноющего характера, постепенно нарастает, усиливается при движении, поворотах и наклонах, мышечном напряжении, подъёме тяжестей, кашле и чихании. Характерны повторные обострения на протяжении нескольких лет, может отдавать в ягодицу, ногу и далее по ноге до стопы («лампасные» боли)</li>\r\n<li>Прострелы — острая боль в пояснице, возникает внезапно, затем проходит (более половины больных связывают появление этой боли с конкретной травмой — падением, резким наклоном или поворотом туловища, подъёмом тяжести);</li>\r\n<li>Онемение, жжение, покалывание в ногах, «мурашки»;</li>\r\n<li>Изменение осанки с целью уменьшения боли – сколиоз;</li>\r\n<li>Симптом Ласега — появление боли в пояснице и в участке кожи, который иннервируется поражённым корешком (возможно также чувство онемения, ползания мурашек) при поднятии выпрямленной ноги у лежащего на спине пациента. Боль исчезает (или ослабевает) при сгибании ноги в коленном суставе и усиливается при тыльном сгибании стопы;</li>\r\n<li>Синдром каудогенной перемежающейся хромоты — боль в ногах при ходьбе (вследствие преходящего сдавления конского хвоста), вынуждающая больного останавливаться</li>\r\n<li>Вегетативные проявления: потливость, мраморность кожи</li>\r\n<li>В запущенных случаях — нарушение работы мочевого пузыря и кишечника, атрофия мышц ног, паралич.</li>\r\n</ul>\r\n<p> </p>",
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4938
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