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},
"code": "M35.3",
"name": "Ревматическая полимиалгия",
"icd_name": "Ревматическая полимиалгия",
"gender": 0,
"age_min": 50,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "m35.3_revmaticheskaya_polimialgiya",
"lead": "воспалительное заболевание костно-мышечной системы",
"description": "<p><span id=\"docs-internal-guid-1982544d-7fff-4eff-6ad6-d3ec4573e73c\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Ревматическая полимиалгия - это патология воспалительного характера, проявляющаяся мышечными болями неясного происхождения в области плечевого и тазового поясов, локализующимися, как правило, в плечевой, шейной, позвоночной, а также бедренной и ягодичной зонах. </span></span></p>",
"etiology": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Этиологические факторы ревматической полимиалгии неизвестны. Очевидно ведущее значение нарушений в иммунной сфере и наследственности, обсуждается пусковая роль сенсибилизирующих и инфекционных (аденовирус, вирус парагриппа) агентов. Провоцировать и поддерживать течение ревматической полимиалгии может гигантоклеточный темпоральный артериит (болезнь Хортона).</span></p>",
"pathogenesis": "",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Диагностикой и лечением ревматической полимиалгии занимается ревматолог. Специфические изменения в периферической крови при ревматической полимиалгии не выявляются; обнаруживается лишь умеренная анемия и рост СОЭ. При исследовании венозной крови на биохимию отмечается повышение СРБ при отрицательных лабораторных тестах на РФ и LE-клетки.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Рентгенологически крайне редко обнаруживаются эрозии, уменьшение ширины суставной щели; у пациентов преклонного возраста – явления остеоартроза. УЗИ сустава и томографическая (МРТ, ПЭТ) диагностика при ревматической полимиалгии подтверждают воспалительные изменения. При микроскопии синовиальной жидкости выявляется наличие нейтрофильного лейкоцитоза. Исследование биоптата синовиальной мембраны обнаруживает признаки умеренного неспецифического синовита. Биопсия мышц при ревматической полимиалгии не информативна.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основная цель фармакотерапии – достижение лекарственной ремиссии, а также предупреждения риска коморбидных заболеваний.</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #525358; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">главное место в лечебном процессе занимает медикаментозная терапия глюкокортикоидами, (низкие/средние дозы), для купирования обострения и поддержания клинической ремиссии;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #525358; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">для сокращения кумулятивной дозировки ГК возможно назначение метатрексата – МТ, как стероидосберегающего средства;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #525358; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">во время лечения требуется тщательно контролировать эффективность проводимых процедур, подбирать дозу ГК в зависимости от активности недуга;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #525358; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">при выборе дозировки глюкокортикоидов следует учитывать длительность заболевания, степень воспалительной активности, частоту рецидивов, ответ на проводимые лечебные мероприятия и сопутствующую патологию;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #525358; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">при сочетании РПМ с гигантоклеточным артериитом необходимо применять более высокие дозы ГК внутрь, а также в ряде случаев проводить пульс-терапию метилпреднизолоном;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #525358; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">для уменьшения болевого синдрома, связанного с сопутствующим остеохондрозом, артрозом, возможен прием НПВП. </span></p>\r\n</li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечение ревматической полимиалгии подразделяется на несколько стадий: начальную (глюкокортикоидоами), поддерживающую (снижение ГК) и период отмены.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Начальная терапия:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #525358; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">преднизолон в количестве 10-20 мг/сутки</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #525358; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">при достижении клинической ремиссии проводят постепенное уменьшение ГК с 15 до поддерживающей дозировки 10 мг/сутки, далее – менее 1мг/сутки. </span></p>\r\n</li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Стероидосберегающие препараты: цель их применения – сократить продолжительность приема глюкокортикоидов и тем самым снизить риск нежелательной реакции.</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #525358; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">МТ внутрь и в/м в комбинации с преднизолоном дает стероидосберегающий эффект, снижает количество рецидивов, сокращает продолжительность лечения и кумулятивную дозу;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #525358; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">при недостаточной эффективности и переносимости МТ для приема внутрь целесообразно назначение парентеральной (подкожной) формы препарата;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #525358; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">при рефрактерном ГК-течении РПМ и наличии противопоказаний к длительному приему глюкокортикоидов требуется применение тоцилизумаба. </span></p>\r\n</li>\r\n</ul>",
"prevention": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Профилактика ревматической полимиалгии не выработана.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Течение заболевания характеризует острое начало с резким развитием фебрильной или субфебрильной лихорадки и ярко выраженной интоксикацией. Затем начинают формироваться множественные миалгии в шейной плечевой, позвоночной, бедренной и ягодичной областях. Выраженность их интенсивная, характер – режущий, тянущий или дергающий. Боль наблюдается постоянно – она усиливается с утра и после длительного отсутствия движений. Причём, миалгии возникают не только в движущихся мышцах, но и в подверженных исключительно статической нагрузке, поэтому больной вынужден постоянно изменять положение. Симптоматика РПМ не зависит от погодных условий, в частности – от перегрева или переохлаждения.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Ревматическая полимиалгия характеризуется следующими проявлениями:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #525358; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">боли в предплечье, шее, позвоночнике, бёдрах;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #525358; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">выраженная общая слабость, утомляемость;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #525358; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">мышечная слабость, понижение двигательной функции суставов;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #525358; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">скованность в движениях вплоть до затруднений при простейших действиях (смене позы тела и поднятии головы в положении лёжа, подъёме и спуске по лестнице и т.п.);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #525358; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">появление характерной семенящей походки с мелким частым шагом. </span></p>\r\n</li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При ослабленном иммунитете и слабом здоровье пациента РПМ может сопровождаться дополнительными симптомами:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #525358; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">гипертермией (повышенной температурой);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #525358; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">снижением веса (вплоть до анорексии);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #525358; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">потерей аппетита;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #525358; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">потливостью по ночам;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #525358; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">сонливостью;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #525358; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">подавленным состоянием (вплоть до депрессии). </span></p>\r\n</li>\r\n</ul>",
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},
"code": "M40",
"name": "Кифоз и лордоз",
"icd_name": "Кифоз и лордоз",
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3
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"lead": "Кифоз - прогиб позвоночника назад, лордоз - прогиб позвоночника вперед. Как правило если в одном отделе позвоночника развивается кифоз, то в другом отделе почти неминуемо развивается компенсационный лордоз, и наоборот",
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"etiology": "<p><a href=\"/symptom/kifoz_i_lordoz/\" title=\"Перейти на страницу симптома Кифоз и лордоз\">Кифоз</a> – <a href=\"/symptom/anormalnoe_polozhenie_tela/\" title=\"Перейти на страницу симптома Анормальное положение тела\">искривление</a> позвоночника, обращенное выпуклостью кзади. У взрослых в норме бывает физиологический грудной и крестцовый <a href=\"/symptom/kifoz_i_lordoz/\" title=\"Перейти на страницу симптома Кифоз и лордоз\">кифоз</a>. Патологический <a href=\"/symptom/kifoz_i_lordoz/\" title=\"Перейти на страницу симптома Кифоз и лордоз\">кифоз</a> может быть углообразным вследствие туберкулеза одного или нескольких позвонков или травмы позвоночника либо дугообразным при рахите, вялом параличе, когда в процесс вовлекается много позвонков. При искривлении всего позвоночника говорят о сутулости, а если <a href=\"/symptom/anormalnoe_polozhenie_tela/\" title=\"Перейти на страницу симптома Анормальное положение тела\">искривление</a> наблюдается в верхнем отделе позвоночника – округлой спине. <a href=\"/symptom/kifoz_i_lordoz/\" title=\"Перейти на страницу симптома Кифоз и лордоз\">Кифоз</a> становится более фиксированным, не поддающимся устранению при длительно существующей порочной осанке. Возможно развитие стойкого кифоза при нарушении процесса окостенения позвонков.</p>",
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"diagnostics": "<p>Ранняя и правильная диагностика помогает вовремя принять адекватные меры и быстро избавиться от заболевания. Тяжелые формы заболевания чрезвычайно трудно поддаются лечению, потому что они сопровождаются деформацией ребер, грудины, ключиц, таза и плечевого пояса.</p>",
"treatment": "<p>В первую очередь необходимо выполнять упражнения, укрепляющие мышцы спины. С лечебной гимнастикой сочетают применение корсетов, массаж, проводят физиотерапию. В случаях, когда причиной кифоза стали туберкулез, опухоль, остеомиелит или другие заболевания, возникает необходимость в оперативном вмешательстве. </p>\r\n<p><a href=\"/symptom/kifoz_i_lordoz/\" title=\"Перейти на страницу симптома Кифоз и лордоз\">Лордоз</a> – изгиб позвоночника, направленный выпуклостью кпереди. Умеренно выраженный <a href=\"/symptom/kifoz_i_lordoz/\" title=\"Перейти на страницу симптома Кифоз и лордоз\">лордоз</a> шейного и поясничного отделов позвоночника является физиологическим. Они формируются на первом году жизни ребенка, создавая основу для удержания головы и всего тела в вертикальном положении. При патологических состояниях возможно углубление лордоза – гиперлордоз, он может сочетаться с другими искривлениями. Гиперлордоз в поясничном отделе позвоночника встречается при спондилолистезе, рахите, во время беременности, при контрактурах тазобедренных суставов. Также гиперлордоз может вызвать деформация шейных позвонков или стягивающие рубцы в области шеи после ожогов. При данном заболевании нарушается осанка, развиваются дистрофические процессы в межпозвоночных дисках, на этом фоне могут возникать боли.</p>",
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"clinical_picture": "<p>В результате нарушений осанки слабеют мышцы спины, это способствует зафиксированию неправильной позы. При угловом кифозе образуется горб. Для рахитического кифоза характерны уплощение и западение грудной клетки, отвисание живота, углубление поясничного лордоза, опущение плеч. При стойком кифозе дыхательные экскурсии грудной клетки ограничиваются, ослабевают мышцы спины, гибкость тела снижается, больной быстро утомляется, ощущаются боли в спине, значительно снижается трудоспособность человека.</p>",
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"lead": "Боль в спине — одна из наиболее распространенных причин обращения к врачам. Она же нередко становится причиной инвалидизации по всему миру. В соответствии со статистическими данными, более 70% населения планеты хотя бы один раз испытывали боль в спине и в области поясницы. Боль в спине может быть симптомом к опасным заболеваниях, при появлении данного симптома необходимо обратиться врачу.",
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},
"code": "M40.0",
"name": "Кифоз позиционный",
"icd_name": "Кифоз позиционный",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "m40.0_kifoz_pozicionnyy",
"lead": "заболевание опорно-двигательного аппарата, которое выражается в искривлении позвоночника в передне-заднем направлении",
"description": "",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Патология может возникнуть вследствие нарушений внутриутробного развития, неблагоприятной наследственности, травм и операций на позвоночнике, слабости мышц спины при недостаточных физических нагрузках и т. д. У пожилых людей (особенно – женщин) кифоз часто развивается вследствие патологических компрессионных переломов грудных позвонков. Причиной таких переломов становится остеопороз – уменьшение плотности костей.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Кроме того, кифоз может формироваться при некоторых инфекционных и неинфекционных заболеваниях: спондилите, анкилозирующем спондилите (болезни Бехтерева) и опухолях позвоночника. Очень редко причиной возникновения патологического кифоза становится лучевая терапия, проводимая для лечения злокачественных новообразований в детском возрасте.</span></p>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Чрезмерное искривление грудного отдела оказывает неблагоприятное влияние как на анатомические структуры самого позвоночника, так и на расположенные рядом органы. Объем грудной клетки и емкость легких при максимальном вдохе уменьшаются. Недостаточное поступление кислорода в кровь обуславливает нарушения со стороны системы кровообращения и других систем.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Диафрагма сильнее давит на брюшную полость, из-за чего нарушается нормальная работа расположенных там органов, в частности – развиваются запоры. Из-за перераспределения нагрузки страдают межпозвоночные диски, возникает остеохондроз. При выраженном кифозе возможно сдавление спинного мозга и нервных корешков, сопровождающееся потерей или ослаблением чувствительности, мышечной слабостью и нарушениями со стороны тазовых органов.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Постановка диагноза начинается с подробного опроса и осмотра пациента. Врач (лечением кифозов занимаются травматологи-ортопеды) изучает историю развития болезни, уточняет особенности болевого синдрома, обращает внимание на отсутствие или наличие неврологических нарушений. Осмотр включает в себя пальпацию спины и шеи, определение силы мышц и кожной чувствительности. Специалист исследует сухожильные рефлексы и проводит специальные тесты для оценки неврологического статуса, осуществляет аускультацию сердца и легких.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Обязательным этапом обследования является рентгенография позвоночника, которая может включать в себя как обзорные прямые и боковые снимки, так и прицельные рентгенограммы в нестандартных проекциях и при специально выбранном положении пациента (например, в условиях растягивания позвоночника).</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для выявления патологии со стороны мягких тканей может быть назначено МРТ. Для оценки патологических изменений со стороны костных структур пациента могут направить на компьютерную томографию.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечение чаще консервативное, включает в себя ЛФК для укрепления мышечного корсета спины, массаж и физиопроцедуры. Некоторым пациентам показана мануальная терапия. Ношение корсетов назначается преимущественно для уменьшения болевого синдрома. Однако постоянное использование корсетов в большинстве случаев не рекомендуется, поскольку сами по себе они не исправляют осанку и, к тому же, могут стать причиной ослабления мышц спины с последующим усугублением кифоза.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Показанием к хирургическому вмешательству является:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Стойкий болевой синдром, который не удается устранить консервативными методами.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Быстрое прогрессирование кифоза, особенно – сопровождающееся неврологическими нарушениями, а также нарушениями функции легких и сердца.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Косметический дефект, существенно снижающий качество жизни пациента и препятствующий выполнению профессиональных обязанностей.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Цель операции – по возможности исправить угол изгиба позвоночника и остановить прогрессирование деформации, а также устранить компрессию нервных стволов и защитить их от повреждений в будущем. Хирургические операции на позвоночнике относятся к категории сложных, масштабных вмешательств и проводятся под общим наркозом только после полного обследования пациента. Иногда для достижения желаемого результата требуется несколько операций.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для фиксации позвоночника используются различные конструкции, изготавливаемые из инертных металлов (титана, никелида титана). Они не вызывают реакции отторжения и могут находиться в организме без последствий в течение многих лет.</span></p>",
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"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Клинические проявления и симптомы кифоза различаются в зависимости от причины и тяжести деформации. В дополнение к косметическому дефекту, кифоз может также вызвать боль в спине и скованность у некоторых людей. Умеренные формы кифоза могут не иметь заметных признаков или симптомов.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Боль в средней или нижней части спины является наиболее распространенным симптомом кифоза.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Другие симптомы могут включать в себя следующие:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Трудность дыхания (в тяжелых случаях)</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Усталость</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Округлая спина</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Болезненность и ригидность в позвоночнике</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Закругленные плечи</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Видимый горб на спине</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Легкая боль в спине</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Плотные мышцы хармстринг (мышцы в задней части бедра)</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Редко, со временем, прогрессирование деформации может привести к появлению:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Слабости, онемению или покалыванию в ногах</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Потере чувствительности</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Одышке</span></li>\r\n</ul>\r\n<p> </p>",
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}
]
}