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"code": "S83",
"name": "Вывих, растяжение и перенапряжение капсульно-связочного аппарата коленного сустава",
"icd_name": "Вывих, растяжение и перенапряжение капсульно-связочного аппарата коленного сустава",
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"slug": "s83_vyvih_rastyazhenie_i_perenapryazhenie_kapsulno-svyazochnogo_apparata_kolennogo_sustava",
"lead": "Нарушение здоровья, относящееся к группе травмы колена и голени",
"description": "Вывих коленного сустава – это травма, при которой нарушается целостность компонентов коленного сустава (связок, суставной капсулы, менисков и других), однако кости остаются неповрежденными. Растяжение связок колена возникает в тех случаях, когда одна или несколько связок в колене подвергаются чрезмерной нагрузке, перерастягиваются или разрываются.\r\n\r\n",
"etiology": "<p> Основные причины, способствующие нарушению механизмов работы коленного сустава и вызывающие повреждение связочного аппарата:</p><ul><li>Спортивные травмы;</li><li>Вывихи конечностей вследствие поднятия тяжестей;</li><li>Падение или резкий взмах ногой;</li><li>Резкая остановка во время бега;</li><li>ДТП;</li><li>Неудачное приземление после совершения прыжка (особенно на прямые ноги);</li><li>Приведение или отведение колена.</li><li>В отдельных случаях причиной повреждения коленного сустава становится слабость связочного аппарата, обусловленная генетически.</li></ul>",
"pathogenesis": "<p> </p>\r\n<p>Причиной развития чаще всего становится воздействие на сустав механической силы, приводящее к растяжению связок и повреждению суставной капсулы. Сильное растяжение может привести к надрыву или даже к разрыву связок. При повреждении кровеносных сосудов возможно внутреннее кровотечение в области окружающих сосуд тканей. Обычно поврежденными оказываются и нервы в области сустава. Сам механизм возникновения травмы может быть прямым – когда сила приложена непосредственно на область сустава. Непрямой механизм возникновения вывихов связан с приложением силы вдали от сустава, при этом возникает резкая ротация бедра, чрезмерном отклонении голени в сторону (например, при падении на ноги с высоты) – возникает разрывы связок, менисков.</p>",
"diagnostics": "<p>Диагностические мероприятия включают в себя:</p>\r\n<ul>\r\n<li>Расспрос пострадавшего о характере травмы, визуальный осмотр для определения поврежденных структур сустава и степени тяжести;</li>\r\n<li>МРТ (магнитно-резонансная томография) – делает серию послойных снимков в разных проекциях, на которых четко видны все структуры, включая хрящ, связки и сухожилия;</li>\r\n<li>Компьютерная томография (КТ) – схожий по информативности метод, часто рассматривается как альтернатива МРТ;</li>\r\n<li>УЗИ колена (ультразвуковое исследование) позволит врачу детально рассмотреть область сустава. Это один из самых доступных методов;</li>\r\n<li>Артроскопия – эндоскопический метод исследования суставной полости изнутри. Его относят к малым хирургическим операциям. Применяют с целью как диагностики, так и лечения – например, когда иными способами не удается установить характер травмы и степень повреждения. С помощью артроскопии производят ушивание связок, остановку кровотечения и другие лечебные процедуры;</li>\r\n<li>Рентген в нескольких проекциях при повреждении связочного аппарата колена применяется как вспомогательный метод, поскольку не позволяет увидеть связки и мягкие околосуставные ткани. Глядя на рентгеновские снимки, врач может судить о характере повреждения только по косвенным признакам.</li>\r\n</ul>",
"treatment": "<p> </p>\r\n<p> Лечение вывиха </p>\r\n<p>Вывих коленного сустава требует хирургического лечения, поскольку эта травма сопровождается повреждением не только суставных тканей, но и близлежащих структур – нервов, сосудов и других.</p>\r\n<p>Вывих голени – очень тяжелая травма, при которой существует большая вероятность развития шока. Поэтому на первом этапе лечения обязательно проводят противошоковую терапию, которая включает:</p>\r\n<ul>\r\n<li>Адекватное обезболивание как с помощью нестероидных противовоспалительных препаратов, так и наркотических анальгетиков.</li>\r\n<li>Наложение шины от ягодицы до стопы включительно, чтобы обездвижить конечность.</li>\r\n<li>Постановку капельницы для поддержания работы сердечно-сосудистой системы.</li>\r\n</ul>\r\n<p>Категорически запрещено вправлять вывих коленного сустава в условиях травмпункта, а тем более самостоятельно – это чревато повреждением подколенных нервов и кровеносных сосудов. Вправление производят в больнице под общим наркозом, чтобы восстановить целостность поврежденных тканей, после чего на конечность накладывают гипсовую повязку.</p>\r\n<p>После снятия гипсовой повязки назначают:</p>\r\n<ul>\r\n<li>лечебную гимнастику,</li>\r\n<li>физиотерапию,</li>\r\n<li>санаторно-курортное лечение,</li>\r\n<li>поддерживающую медикаментозную терапию.</li>\r\n</ul>\r\n<p>Даже после технически успешного вправления вывиха после снятия гипсовой повязки в коленном суставе часто сохраняется избыточная подвижность и «разболтанность», и нога теряет свою опорную функцию. Поэтому в ранние сроки после травмы проводят реконструктивную («восстановительную») операцию, которая направлена на стабилизацию структур и тканей колена, с последующей реабилитацией.</p>\r\n<p>Лечение травмы мениска:</p>\r\n<p>В минуты после травмы, вне зависимости от степени выраженности, пациенту нужна первая помощь, в дальнейшем ее своевременное оказание может облегчить процесс лечения:</p>\r\n<ul>\r\n<li>нога пациента укладывается выше уровня его груди – это позволяет не допустить отекания или снизить степень отека;</li>\r\n<li>поврежденная нога должна находиться в полном покое;</li>\r\n<li>необходимо поставить холодный компресс и замотать эластичным бинтом область травмированного сустава.</li>\r\n</ul>\r\n<p>Дальнейшее консервативное лечение включает прием нестероидных противовоспалительных средств для снятия боли, уменьшения воспаления и отека. После лечения в рамках реабилитации назначается курс физиотерапевтических процедур, мануальный массаж и упражнения ЛФК.</p>\r\n<p>Пациенту назначаются хондропротекторы – вещества, восстанавливающие хрящевую ткань. Терапию хондропротекторами нужно проводить курсами каждый год, по 3-6 месяцев.</p>\r\n<p> Показания для операции включают:</p>\r\n<ul>\r\n<li>разрыв мениска со смещением;</li>\r\n<li>раздавливание или размозжение хрящевой ткани;</li>\r\n<li>полный отрыв мениска и обоих рогов;</li>\r\n<li>кровь в суставной капсуле (гемартроз);</li>\r\n<li>низкий или отсутствующий эффект от терапии медикаментами в течение 2-3 недель.</li>\r\n</ul>\r\n<p>Хирургическая операция придерживается максимального сохранения целостности мениска, если это возможно, и восстановления его функций.</p>\r\n<p>Используемые методы:</p>\r\n<ul>\r\n<li>Менискэктомия: удаляется оторванный мениск или его большая часть, проводится также при дегенерации хряща, присоединившихся осложнениях.</li>\r\n<li>Неполное удаление мениска: убирается оторванная часть и после проводится урезание его края до необходимого состояния.</li>\r\n<li>Пересадка мениска: используется донорский или искусственный мениск. Проводится при размозжении тканей и прогнозируемом значимом ухудшении качества жизни.</li>\r\n<li>Восстановление мениска: сшивают поврежденные части для сращения. Операция проводится в случаях, если мениск разорван в периферии; разрыв является продольным и вертикальным; мениск оторван от капсулы; нет дегенерации в хряще; разрыв «свежий» с локализацией в красной или промежуточной области; молодой возраст.</li>\r\n<li>Артроскопия коленного сустава: наименее травматичный метод, используемый в настоящее время. Колено в двух определенных местах прокалывают по 1 см. В один из проколов вводится артроскоп и физраствор, в другом проколе проводят инструментами необходимые внутренние манипуляции в суставе.</li>\r\n<li>Скрепление мениска: разорванные части скрепляются рассасывающимися фиксаторами, без дополнительных разрезов.</li>\r\n</ul>\r\n<p>Лечение растяжения связок</p>\r\n<p>Лечение при легкой степени патологии:</p>\r\n<ul>\r\n<li>Иммобилизация – фиксация ноги в неподвижном или малоподвижном состоянии при помощи эластичного бинта или брейса (специального бандажа);</li>\r\n<li>Охлаждение – направлено на уменьшения отечности и болевого синдрома. Осуществляется пи помощи прикладывания к пораженному участку охлаждающего пакета или пузыря со льдом;</li>\r\n<li>Возвышенное положение – способствует схождению отека. Необходимо проводить в положении лежа с приподнятой конечностью большую часть суток.</li>\r\n</ul>\r\n<p>Лечение легкой степени поражения в некоторых случаях требует назначения обезболивающих и противовоспалительных препаратов. Физиотерапевтические тепловые процедуры в данном случае приветствуются, так как помогают быстрее восстановить связочный аппарат.</p>\r\n<p>При средней степени травмирования накладывается гипсовая повязка на срок от 3 до 4 недель, а также назначаются общеукрепляющие и противовоспалительные средства, а также физиопроцедуры теплового характера, гимнастика и массаж. Тяжелая степень растяжения требует хирургического вмешательства, которая направлена на восстановление поврежденной суставной структуры. После операции больной находится в ортопедическом или травматологическом стационаре, где на пораженную конечность на срок в 2 месяца накладывается гипс.</p>",
"prevention": "<p> Чтобы уменьшить риск травм колена необходимо придерживаться следующих правил:</p>\r\n<ul>\r\n<li>Используйте средства защиты коленных суставов: носите специальную экипировку, предназначенную для занятий конкретным видом спорта.</li>\r\n<li>Всегда надевайте на тренировки удобную спортивную обувь на пружинящей подошве.</li>\r\n<li>Укрепляйте мышцы ног, выполняя специальные упражнения.</li>\r\n<li>Занимаясь силовыми тренировками – наращивайте нагрузку постепенно. Пользуйтесь рекомендациями только опытных инструкторов.</li>\r\n<li>ношение обуви, хорошо поддерживающей ноги, применение специальных стелек;</li>\r\n<li>повышенное внимание к состоянию дороги во время ходьбы и вождения автомобиля в зимний период;</li>\r\n<li>соблюдение правил техники безопасности на производстве;</li>\r\n<li>избавление от лишнего веса, увеличивающего нагрузку на ноги.</li>\r\n</ul>",
"clinical_picture": "<p>Признаки растяжения связок колена:</p><ul><li>Затруднение движения в суставе (колено стало более тугоподвижным или вообще не двигается, при полном разрыве);</li><li>Боль и болезненные ощущения при пальпации в колене;</li><li>Болезненные щелчки и хруст при движениях.</li><li>Припухлость или наличие кровоподтеков. Они возникают не сразу, а в течение первых нескольких часов после растяжения связок. Наряду с разрывом волокон связок нарушается целостность сосудов, поэтому окружающие ткани могут пропитываться кровью.</li><li>Нестабильность коленного сустава. Колено скованно или же наоборот, ощущается \"разболтанность\" или \"выпадение\" при ходьбе - это может говорить о тяжелой степени травмы (в том числе, о полном разрыве).</li></ul><p>Независимо от конкретного механизма возникновения повреждения, вывих коленного сустава в типичных случаях сопровождается следующими симптомами:</p><ul><li>Острая боль в суставе, сохраняющаяся в покое и значительно усиливающаяся при движениях. Возникновение этих симптомов обусловлено непосредственным повреждением нервных волокон.</li><li>Нарушение подвижности. Коленный вывих сопровождается либо значительным уменьшением амплитуды движений, либо полной невозможностью двигать ногой в колене.</li><li>Потеря чувствительности стопы. Это грозный симптом, который указывает на повреждение крупных нервных стволов.</li><li>Отек колена, связанный с нарушением целостности сосудов и кровоизлиянием в ткани сустава, а также развитием начальных этапов воспалительного процесса.</li></ul><p>При вывихе голени колено деформировано, в передней его части определяется заостренный выступ (штыкообразная деформация). Из-за сильной боли и неустойчивости на поврежденную ногу невозможно опираться, она выпрямлена и несколько укорочена. При подвывихе голени нога несколько согнута.</p><p>Симптомы, на основании которых можно заподозрить разрыв мениска коленного сустава:</p><ul><li>боль – бывает очень резкой в момент травмы в течение 1-2 минуты. Появлению острой боли в колене может предшествовать что-то наподобие щелчка. Через некоторое время сильные болезненные ощущения могут ослабеть, человек может даже ходить, хотя и через силу. Однако с утра наблюдается ощущение «гвоздя» в колене. При попытке резко согнуть или разогнуть ногу боль усиливается, в состоянии покоя немного стихает. Интенсивная боль характерна для молодых людей;</li><li>блокада или «заклинивание» сустава – очень частый признак, характеризующий разрыв заднего рога внутреннего мениска. Блокада происходит тогда, когда оторвавшаяся или надорвавшаяся часть мениска загибается между костями и нарушает двигательную функцию сустава. Правда, это может произойти и от разорвавшихся связок;</li><li>гемартроз (кровь в суставе) появляется тогда, когда надрывается зона мениска, пронизанная капиллярами;</li><li>отек сустава – происходит, как правило, на 2-3 день.</li></ul><p> </p>",
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