Disease List

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            },
            "code": "L63",
            "name": "Гнездная алопеция",
            "icd_name": "Гнездная алопеция",
            "gender": 0,
            "age_min": 0,
            "age_max": 100,
            "cause": [
                3,
                0
            ],
            "periodicity": 1,
            "slug": "l63_gnezdnaya_alopeciya",
            "lead": "хроническое органоспецифическое аутоиммунное воспалительное заболевание с  генетической предрасположенностью, характеризующееся поражением волосяных фолликулов, стойким или временным нерубцовым выпадением волос.",
            "description": "Гнездная алопеция в большинстве случаев встречается у молодых людей в возрасте моложе 25 лет, заболевание одинаково часто поражает мужчин и женщин. Существует несколько форм патологии: диффузная, локальная, субтотальная, офиазис, тотальная и универсальная.",
            "etiology": "<p> В основе развития лежат ферментные нарушения в волосяных фолликулах, спастическое состояние сосудов, т. е. нарушение микроциркуляции крови в области дермы.Триггерными факторами заболевания могут являться стрессы, вакцинация, вирусные заболевания, инфекционные заболевания, прием антибактериальных препаратов, наркозы.</p>",
            "pathogenesis": "",
            "diagnostics": "<ul>\r\n<li>Диагноз ставится на основании клинической картины заболевания:</li>\r\n<li>■ наличия на коже очагов алопеции с четкими границами;</li>\r\n<li>■ наличия в  очаге пеньков волос в  виде восклицательного знака и зоны «расшатанных волос» на границе очага (активная стадия); ■</li>\r\n<li>обнаружения при микроскопическом исследовании эпилированных из очага волос дистрофичных проксимальных концов в виде «оборванного каната»;</li>\r\n<li>■ наличия в очаге роста светлых пушковых волос (в стадии регресса); иног- да по одному краю очага имеются обломки волос в виде восклицательно- го знака, а на противоположном — рост веллюса;</li>\r\n<li>■ обнаружения при осмотре ногтей признаков ониходистрофии: напер- стковидных вдавливаний, продольной исчерченности, изменений сво- бодного края в виде волнистых узур;</li>\r\n<li>■ выявления при трихоскопии (дерматоскопии волосистой части головы) «желтых точек», кадаверизированных волос, волос в виде восклицатель- ных знаков. При сомнительном диагнозе, а также перед назначением лечения реко- мендуется проведение лабораторных исследований:</li>\r\n<li>■ микроскопического исследования кожи и волос на наличие патогенных грибов;</li>\r\n<li>■ микроскопического исследования волос, эпилированных из краевой зоны очага (выявление дистрофичных концов волос — признака, пато- гномоничного для ГА);</li>\r\n<li>■ гистологического исследования фрагмента кожи волосистой части голо- вы. Гистологически ГА характеризуется состоящим в основном из Т-кле- ток воспалительным инфильтратом внутри и вокруг луковиц анагеновых волосяных фолликулов. Однако гистопатологические признаки ГА зави- сят от стадии заболевания, в  случае хронического течения заболевания классические признаки могут отсутствовать;</li>\r\n<li>■ клинического анализа крови;</li>\r\n<li>■ серологических исследований для исключения красной волчанки и  си- филиса;</li>\r\n<li>■ определения в крови уровня кортизола (при планировании лечения глю- кокортикоидными средствами системного действия — до лечения и спу- стя 4 недели после его окончания);</li>\r\n<li>■ биохимического анализа крови: АЛТ, АСТ, общий белок, билирубин, хо- лестерин, сахар крови, щелочная фосфатаза (при подозрении на токсиче- скую алопецию, а также перед назначением фотохимиотерапии с приме- нением фотосенсибилизаторов внутрь);</li>\r\n<li>■ обзорной рентгенографии черепа (для исключения объемных образова- ний области турецкого седла);</li>\r\n<li>■ анализа крови на гормоны щитовидной железы (Т3 свободного, Т4 сво- бодного, ТТГ, АТ к ТПО, АТ к ТГ) для исключения патологии щитовидной железы и пролактин для исключения геперпролактинемии. Реовазоэнцефалограмма (РЭГ) рекомендуется при распространенных формах ГА детям в возрасте до 12 лет с целью диагностики возможных нарушений кровообращения в системе церебральных сосудов. По показаниям назначаются консультации других специалистов: невро- лога, эндокринолога, психотерапевта.</li>\r\n</ul>",
            "treatment": "<p>Лечение гнездовой алопеции проводится с помощью введения глюкокортекостероидов в патологические очаги, смысл этой терапии заключается в иммуносупрессивном действии препаратов. Если площадь поражения составляет более 50 % кожных покровов головы, на которых происходит рост волос, то лечение кортикостероидами не оказывает нужного эффекта.</p>\r\n<p>На сегодняшний день местное лечение препаратами, содержащими кортикостероиды, признано малоэффективным даже в сочетании с носителями, способствующими более глубокому проникновению гормональных препаратов.</p>\r\n<p>Топическая иммуносупрессивная терапия гнездной алопеции может проводиться с применением динитрохлорбензола, дибутилового эфира скваровой кислоты и дифенилциклопропенона.</p>\r\n<p>Правильно подобранное системное использование стероидов способно повернуть быстро прогрессирующую гнездную алопецию вспять.</p>\r\n<p>Подавить активные клоны лимфоцитов можно иммунотропными лекарственными средствами.</p>\r\n<p>В ряде случаев эффективна фотохимиотерапия, а также некоторые адъювантные методы воздействия на очаги поражения.</p>\r\n<p>При выборе методов лечения гнездовой алопеции принимают во внимание особенности конституции пациентов, фоновые заболевания.</p>\r\n<p>Использование биогенных стимуляторов позволяет ускорить процессы восстановления тканей. Для коррекции некоторых показателей крови могут быть рекомендованы препараты, содержащие экстракт слюны пиявок. При некоторых формах гнездовой алопеции могут быть показаны препараты цинка.</p>\r\n<p>К наружным средствам сопутствующей терапии относят широкий спектр раздражающих средств (скипидарную мазь, эфкамон), стимуляторы процессов пролиферации креатиноцитов, препараты, улучшающие питание тканей, а также способствующие улучшению микроциркуляции тканей. Наружно могут также использоваться лекарственные средства, содержащие кремний, которые позволяют улучшить структуру волоса, или же препараты, терапевтический эффект которых обусловлен воздействием на пораженные участки кожи вытяжки из плаценты.</p>",
            "prevention": "<p>Методов профилактики не существует.</p>",
            "clinical_picture": "<p>Заболевание начинается внезапно с появлением очага выпадения волос на волосистой части головы. Как правило, очаги круглые или овальные с неизменной по цвету и консистенции кожей величиной от 1,5 см до размера ладони ребенка. Очаги могут сливаться, образуя обширные участки облысения. Субъективные признаки отсутствуют. Существуют следующие клинические разновидности:</p>\r\n<p>1) мелкоочаговая алопеция (чаще встречаются у детей);</p>\r\n<p>2) лентовидные очаги облысения затылочной части головы, распространяющиеся к вискам, нередко изъязвляющиеся. При регрессии остаются рубцы. Эта форма резистентна к терапии;</p>\r\n<p>3) стригущая форма – в очаге облысения определяются обломанные волосы;</p>\r\n<p>4) субтотальная – почти полное или полное <a href=\"/symptom/vypadenie_volos/\" title=\"Перейти на страницу симптома Выпадение волос\">выпадение волос</a> на голове;</p>\r\n<p>5) тотальная (злокачественная) алопеция – полное <a href=\"/symptom/vypadenie_volos/\" title=\"Перейти на страницу симптома Выпадение волос\">выпадение волос</a> на голове, туловище, конечностях, включая ресницы и брови.</p>",
            "image": "http://api.symptomd.ru/storage/5528df44039b283703ffa9cfdc8b9b97_gpBpCXo.jpg",
            "image_alt": "Алопеция",
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            },
            "code": "G44.2",
            "name": "Головная боль напряженного типа",
            "icd_name": "Головная боль напряженного типа",
            "gender": 0,
            "age_min": 10,
            "age_max": 100,
            "cause": [
                "0"
            ],
            "periodicity": 1,
            "slug": "g44.2_golovnaya_bol_napryazhennogo_tipa",
            "lead": "одна из наиболее распространенных форм первичной головной боли, проявляющаяся болевыми эпизодами продолжительностью от 30 минут до нескольких суток",
            "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;\">В современной медицине головную боль напряжения рассматривают исключительно как нейробиологическое заболевание. Предположительно в этиологии головной боли напряжения принимают участие не только центральные, но и периферические ноцицептивные механизмы. Ведущую роль патогенез головной боли напряжения играет повышенная чувствительность болевых структур, а также недостаточная функция нисходящих тормозных путей мозга.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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;\">Основной провоцирующий фактор приступа головной боли напряжения &mdash; эмоциональный стресс. Доказано, что переключение внимания или положительные эмоции способны снижать интенсивность головной боли вплоть до полного ее исчезновения. Однако через некоторое время головная боль возвращается. Еще один провоцирующий фактор &mdash; т. н. мышечный фактор, т. е. длительное нахождение в напряжении без смены позы (вынужденное положение головы и шеи при работе за столом и при вождении транспорта).</span></p>\r\n<p>&nbsp;</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;\">Существуют также факторы, формирующие хронический паттерн боли. Один из таких факторов &mdash; депрессия. Кроме травмирующих жизненных ситуаций развитию депрессии способствуют и особенности личности, те или иные ее поведенческие особенности. Другой фактор хронизации &mdash; лекарственный абузус (злоупотребление симптоматическими обезболивающими препаратами). Доказано, что в случае потребления большого количества обезболивающих препаратов хроническая головная боль напряжения формируется в два раза чаще. Для лечения абузусной головной боли необходимо как можно раньше отменить препарат, вызвавший данное осложнение.</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;\">Повышение в мышцах чувствительности болевых рецепторов - специальных клеток, ответственных за передачу болевого сигнала в головной мозг - имеет большое значение при возникновении эпизодической головной боли, в то время как избыточная чувствительность болевых путей в центральной нервной системе из-за длительной стимуляции перенапряженных мышц, по-видимому, приводит к переходу эпизодической головной боли в хроническую.&nbsp;</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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;\">Таким образом, стимулы от мышц, которые обычно безвредны, ошибочно принимаются за боль при хронической тензионной боли.</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;\">Основными отличительными чертами головных болей напряжения являются:</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;\">длительность приступа от 30 минут до 7 дней;</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;\">отсутствие тошноты и рвоты;</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;\">наличие либо фотофобии (боязни света) либо фонофобии (непереносимости громких звуков), но не их одновременного сочетания;</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;\">отсутствие связи с другими расстройствами.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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;\">О ГБН свидетельствует наличие болей, отвечающих как минимум 2-м из следующих параметров:</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;\">двусторонняя локализация;</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;\">давящий или сжимающий характер, но никогда не пульсирующий;</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;\">низкая или умеренная интенсивность;</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;\">отсутствие усиления при обыденных физических нагрузках, в частности при ходьбе, подъеме или спуске по лестнице.</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;\">Если в ходе осмотра и опроса пациента обнаружены другие симптомы, нехарактерные для головных болей напряжения, назначаются дополнительные методы исследования:</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;\">КТ или рентген шейного отдела позвоночника;</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;\">МРТ шейного отдела позвоночника и головы;</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;\">УЗДГ сосудов шеи и головы и т. д.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</p>\r\n<p>&nbsp;</p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</p>\r\n<p><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;\">&nbsp;</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;\">В лечении головной боли напряжения неврологи применяют комплексный подход. Во-первых, необходимо нормализовать эмоционально состояние пациента, во-вторых, устранить дисфункцию перикраниальных мышц. Кроме того, необходимо принять меры по предотвращению лекарственного абузуса. Результатом такого лечения становится уменьшение болевого и мышечно-тонического синдрома, предотвращение трансформации эпизодической головной боли напряжения в хроническую ГБН.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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;\">В качестве медикаментозного лечения головной боли напряжения применяют следующие группы препаратов и процедуры:</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;\">антидепрессанты (селективные ингибиторы обратного захвата серотонина, селективные ингибиторы обратного захвата серотонина и норадреналина);</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;\">миорелаксанты (толперизон, тизанидин);</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;\">НПВС (диклофенак, напроксен, кетопрофен);</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;\">препараты для профилактического лечения мигрени (в случае сочетания головной боли напряжения с мигренью);</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;\">блокады затылочного нерва.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</p>\r\n<p>&nbsp;</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;\">В качестве немедикаментозных методов лечения головной боли напряжения применяют акупунктуру, мануальную терапию, массаж, релаксационную терапию, биологически обратную связь.</span></p>",
            "prevention": "<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;\">Важными компонентами предупреждения приступов боли и их прогрессирования являются:&nbsp;</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;\">выработка навыков психоэмоциональной и мышечной релаксации;</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">избегание/преодоление индивидуальных болевых триггеров</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;\">ограничение употребления анальгетических фармакологических средств.&nbsp;</span></li>\r\n</ul>\r\n<p>&nbsp;</p>\r\n<p><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;\">&nbsp;</span></p>",
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            "code": "M17",
            "name": "Гонартроз [артроз коленного сустава]",
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            "lead": "прогрессирующее разрушение коленного сустава, сопровождаемое его воспалением и деформацией",
            "description": "<p>&nbsp;</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;\">Гонартроз - это хроническое заболевание, в основе которого лежат&nbsp; дегенеративно-дистрофические процессы, затрагивающие главным образом хрящ, а также другие структуры сустава, в результате чего нарушается опорная и двигательная функция.</span></p>",
            "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;\">В большинстве случаев невозможно выделить какую-то одну причину развития патологии. Как правило, возникновение гонартроза обусловлено сочетанием нескольких факторов, в числе которых:</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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: 6.999999999999999pt; 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;\" 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;\">Травмы. Примерно 20-30% случаев гонартроза связано с предшествующими травмами: переломами голени (особенно внутрисуставными), повреждениями менисков, надрывами или разрывами связок. Обычно гонартроз возникает через 3-5 лет после травматического повреждения, хотя возможно и более раннее развитие болезни &ndash; через 2-3 месяца после травмы.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; 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;\" 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;\">Физические нагрузки. Нередко манифестация гонартроза связана с чрезмерными нагрузками на сустав. Возраст после 40 лет &ndash; период, когда многие люди понимают, что для поддержания организма в хорошем состоянии необходимы регулярные физические нагрузки. Начиная заниматься, они не учитывают возрастные изменения и излишне нагружают суставы, что ведет к быстрому развитию дегенеративно-дистрофических изменений и появлению симптомов гонартроза. Особенно опасны для коленных суставов бег и интенсивные быстрые приседания.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; 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;\" 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;\">Лишний вес. При избыточной массе тела нагрузка на суставы увеличивается, чаще возникают как микротравмы, так и серьезные повреждения (разрывы менисков или надрывы связок). Особенно тяжело протекает гонартроз у полных пациентов с выраженным варикозным расширением вен.</span></p>\r\n</li>\r\n</ul>\r\n<p>&nbsp;</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;\">Риск появления гонартроза также увеличивается после перенесенных артритов (псориатического артрита, реактивного артрита, ревматоидного артрита, артрита при подагре или болезни Бехтерева). Кроме того, в числе факторов риска развития гонартроза &ndash; генетически обусловленная слабость связочного аппарата, нарушения обмена веществ и нарушение иннервации при некоторых неврологических заболеваниях, черепно-мозговых травмах и травмах позвоночника.</span></p>\r\n<p><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;\">&nbsp;</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;\">На первой стадии гонартроза нарушается кровообращение в мелких внутрикостных сосудах, питающих гиалиновый хрящ. Поверхность хряща становится сухой и постепенно утрачивает свою гладкость. На его поверхности появляются трещины. Вместо мягкого беспрепятственного скольжения хрящи &laquo;цепляются&raquo; друг за друга. Из-за постоянных микротравм хрящевая ткань истончается и теряет свои амортизационные свойства.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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;\">На второй стадии гонартроза возникают компенсаторные изменения со стороны костных структур. Суставная площадка расплющивается, приспосабливаясь к увеличившимся нагрузкам. Уплотняется субхондральная зона (часть кости, расположенная сразу под хрящом). По краям суставных поверхностей появляются костные разрастания &ndash; остеофиты, которые по своему виду на рентгенограмме напоминают шипы.</span></p>\r\n<p>&nbsp;</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;\">На третьей стадии гонартроза кости значительно деформируются и словно вдавливаются друг в друга, существенно ограничивая движения в суставе. Хрящевая ткань практически отсутствует.</span></p>\r\n<p><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;\">&nbsp;</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;\">Опрос и осмотр врачом травматологом-ортопедом выявляет типичные признаки дегенеративно-дистрофического заболевания сустава (боли при пальпации, ограничение подвижности, крепитация, деформация, наличие выпота в суставе).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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;\">Проводится рентгенологическое исследование коленного сустава (определяется сужение рентгеновской суставной щели, наличие остеофитов, субхондрального склероза), при необходимости &ndash; компьютерная томография сустава.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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;\">Ультразвуковое исследование сустава позволяет обнаружить истончение хряща в суставе, изменения в связках, мышцах, мягких тканях вокруг сустава, воспалительный выпот в полости сустава, изменения менисков.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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;\">Максимально точную информацию даёт магнитно-резонансная томография коленного сустава, выявляющая изменения хрящевой и костной ткани, связок, менисков, синовиальной оболочки, позволяющая дифференцировать посттравматический артроз коленного сустава и артрит, опухолевый процесс.</span></p>\r\n<p>&nbsp;</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;\">Широко используется в диагностике заболеваний сустава диагностическая пункция и артроскопия коленного сустава, а также лабораторное исследование полученной во время процедуры синовиальной жидкости.</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;\">Консервативные мероприятия</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;\">Лечением занимаются травматологи-ортопеды. Терапию гонартроза следует начинать в максимально ранние сроки. В период обострения пациенту с гонартрозом рекомендуют покой для максимальной разгрузки сустава. Больному назначают лечебную гимнастику, массаж, физиотерапию (УВЧ, электрофорез с новокаином, фонофорез с гидрокортизоном, диадинамические токи, магнито- и лазеротерапию) и грязелечение.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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;\">Медикаментозная терапия при гонартрозе включает в себя хондропротекторы (препараты, улучшающие обменные процессы в суставе) и препараты, замещающие синовиальную жидкость. В отдельных случаях при гонатрозе показано внутрисуставное введение стероидных гормонов. В последующем больного могут направить на санаторно-курортное лечение.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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;\">Пациенту с гонартрозом могут порекомендовать ходить с тростью для разгрузки сустава. Иногда используют специальные ортезы или индивидуальные стельки. Для замедления дегенеративных процессов в суставе при гонартрозе очень важно соблюдать определенные правила: заниматься физкультурой, избегая излишних нагрузок на сустав, выбирать удобную обувь, следить за весом, правильно организовать режим дня (чередование нагрузки и отдыха, выполнение специальных упражнений).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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;\">Хирургическое лечение</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">При выраженных деструктивных изменениях (на третьей стадии гонартроза) консервативное лечение малоэффективно. При выраженном болевом синдроме, нарушении функции сустава и ограничении трудоспособности, особенно &ndash; если гонартрозом страдает пациент молодого или среднего возраста прибегают к хирургической операции (эндопротезированию коленного сустава). В последующем проводятся реабилитационные мероприятия. Период полного восстановления после операции по замене сустава при гонартрозе занимает от 3 месяцев до полугода.</span></p>\r\n<p><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;\">&nbsp;</span></p>",
            "prevention": "<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 заболеваний суставов &ndash; это несложно. Если следовать правилам, вопрос как лечить гонартроз вряд ли станет актуальным. Сохранить здоровье суставов помогут:</span></p>\r\n<p>&nbsp;</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: 7.5pt; font-family: Verdana; color: #212529; 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;\">умеренная двигательная активность: пешие прогулки, бассейн, тренажерный зал и т.п.; </span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; 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;\">минимум стрессов и полноценный сон;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; 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;\">сбалансированное и рациональное питание с достаточным количеством витаминов и микроэлементов;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; 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;\">вес в пределах нормы;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; 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;\">минимум вредных факторов на работе: людям, склонным к развитию артроза, стоит избегать ношения тяжестей и длительного нахождения на ногах;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; 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;\">хорошая, удобная обувь (желательно, ортопедическая);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; 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;\">регулярное комплексное обследование организма даже при хорошем самочувствии.</span></p>\r\n</li>\r\n</ul>",
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}