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"code": "N44",
"name": "Перекручивание яичка",
"icd_name": "Перекручивание яичка",
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"lead": "Нарушение здоровья, относящееся к группе болезни мужских половых органов",
"description": "Перекрутом яичка называют ущемление и некроз тканей яичка по причине перекручивания семенного канатика, когда происходит поворот яичка или складки между ним и придатком.",
"etiology": "<p>Среди основных факторов, способных стать причиной развития перекрута яичка, отмечаются следующие: </p>\r\n<ul>\r\n<li>травмы и ушибы мошонки; </li>\r\n<li>резкие рывковые движения (во время активных игр или занятий спортом); </li>\r\n<li>в обстоятельствах, когда имела место высокая подвижность яичка, резкое изменение положения тела; </li>\r\n<li>перенапряжение брюшного пресса; </li>\r\n<li>рефлекторное сокращение поднимающей яичко мышцы; </li>\r\n<li>врожденная аномалия строения половой системы, кроме того, перекрут яичка может происходить еще в утробе матери; </li>\r\n<li>аномалия присоединения придатка к яичку - что исключает возможность нормального крепления яичка ко дну мошонки и определяет их разделение; </li>\r\n<li>незаращивание межоболочечной полости в паховом канале, наличие врожденной пахово-мошоночной грыжи, водянки яичка; </li>\r\n<li>крипторхизм - пороки развития при нарушениях миграции яичек в мошонку. </li>\r\n</ul>",
"pathogenesis": "<p>При любой из форм перекрута резко нарушается кровообращение в яичке и его придатке, в железе наблюдаются ишемические изменения, степень выраженности которых сильно зависит от длительности и степени перекрута, а также от длины семенного канатика (при более коротком канатике степень деструктивных изменений в яичке будет большей). В большинстве случаев при отсутствии лечения через шесть-восемь часов после развития перекрута в яичке развиваются необратимые некротические изменения (иногда кратковременный перекрут может приводить и лишь к атрофии яичка). </p>",
"diagnostics": "<p>При осмотре и пальпации определяется отечность и гиперемия мошонки, подтянутое к внешнему паховому кольцу и малоподвижное яичко на стороне перекрута; консистенция яичка туго-эластичная, семенной канатик утолщен. Попытка поднять яичко еще выше вызывает усиление боли (симптом Прена). </p>\r\n<p>Дополнительные обследования, позволяющие достоверно определить перекрут яичка, включают диафаноскопию (просвечивание), УЗИ органов мошонки и УЗИ сосудов мошонки. </p>\r\n<p>Диагностическая пункция мошонки позволяет определить характер содержимого оболочек (экссудат, кровь, гной). </p>",
"treatment": "<p>Лечение перекрута яичка должно быть начато незамедлительно после установления диагноза. В первые часы после развития заболевания возможно консервативное решение проблемы с помощью наружной ручной деторсии (раскручивания) яичка. </p>\r\n<p>Деторсию яичка выполняют в положении больного лежа на спине; при этом захватывают рукой ткани мошонки вместе с яичком и поворачивают на 180° по направлению, противоположному срединному шву мошонки, с одновременной легкой тракцией яичка вниз. Данную манипуляцию производят несколько раз. Показателями успешного устранения перекрута яичка служат значительное уменьшение или исчезновение болей в мошонке, подвижность яичка и занятие им обычного места в мошонке. При безуспешности нескольких попыток наружной деторсии следует отказаться от консервативной тактики и осуществить хирургическое лечение перекрута яичка. </p>\r\n<p>Операция при перекруте семенного канатика производится через паховый (при вневлагалищной форме) или мошоночный (при внутривлагалищной форме перекрута яичка) доступ. Во время оперативного вмешательства самым ответственным этапом является правильная оценка жизнеспособности яичка. Если после восстановления кровообращения яичко приобретает обычный цвет, производится репозиция яичка и его фиксация к тканям мошонки. </p>\r\n<p>При диагностике некроза яичка показано его удаление – орхиэктомия с последующей имплантацией искусственного яичка для коррекции косметического дефекта. Если в ходе ревизии мошонки выявляется перекрут придатка яичка, его ножку перевязывают у основания, после чего отсекают и удаляют придаток. </p>\r\n<p>В послеоперационном периоде проводятся новокаиновые блокады семенного канатика, физиотерапия, медикаментозная терапия, направленная на улучшение микроциркуляции в поврежденном органе. </p>\r\n<p> </p>\r\n<p>Предупредить перекрут яичка позволяет предупреждение травм органов мошонки, использование защиты при спортивных занятиях, ношение свободной одежды. Больным, перенесшим перекрут яичка, в плановом порядке рекомендуется выполнение превентивной орхипексии с противоположной стороны, позволяющей предотвратить перекрут коллатерального яичка в будущем. При появлении болей и отека в области мошонки следует незамедлительно обратиться к врачу для исключения перекрута яичка.</p>",
"prevention": "<p> Предупредить перекрут яичка позволяет предупреждение травм органов мошонки, использование защиты при спортивных занятиях, ношение свободной одежды. Больным, перенесшим перекрут яичка, в плановом порядке рекомендуется выполнение превентивной орхипексии (пришивание к соседним тканям) с противоположной стороны, позволяющей предотвратить перекрут коллатерального яичка в будущем. При появлении болей и отека в области мошонки следует незамедлительно обратиться к врачу для исключения перекрута яичка.</p>",
"clinical_picture": "<p>Наиболее выраженным симптомом перекрута яичка является внезапная и резкая боль (как в области мошонки, так и в паху и нижней части живота). Часто (особенно у маленьких детей) наблюдается тошнота и рвота. Яичко при перекруте чаще располагается выше своего обычного положения. </p>\r\n<p>Местно могут наблюдаться покраснение кожи и повышение её температуры. Нередко местные симптомы могут быть скудными, тогда как превалируют общие симптомы (боль в животе, рвота, повышение температуры тела, диспептические расстройства). Иногда дополнительным проявлением перекрута яичка может быть острая задержка мочи. Само яичко обычно увеличивается в размерах, при ощупывании определяется его уплотнённая консистенция и болезненность. </p>\r\n<p>При отсутствии своевременного лечения через 18—24 часа боль нередко ослабевает, но продолжают нарастать местные (отёк, гиперемия) и общие симптомы (лихорадка, интоксикация, обычно заметно выраженные лишь у детей). В отдельных случаях (особенно у младенцев) возможно развитие коллаптоидного состояния. </p>",
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"description": "Перелома бедра – это тяжелая травма опорно-двигательного аппарата, в результате которой нарушается анатомическая целостность кости, происходящая из-за воздействия на непрямого удара, падения или полученная в результате скручивания, сгибания.",
"etiology": "<p>В молодом или среднем возрасте обычно случаются переломы верхней части кости из-за падения с высоты или ДТП. Травмирование бедра у пожилых людей случаются в результате прямого удара или падения на область сустава. Переломы шейки бедра может произойти в результате простого спотыкания. Причинами также служат спортивные или производственные травмы.</p>\r\n<p>Механизм перелома у ребенка такой же, как у взрослого человека. Травма случается тоже из-за падения с высоты, перегиба или насильственного скручивания конечности или в результате ДТП. Если в кости развивается патологический процесс, может случиться патологический перелом, возникающий при незначительной травме.</p>\r\n<p>Группа повышенного риска:</p>\r\n<ul>\r\n<li>Самые податливые к травме бедра женщины в пожилом возрасте (каждый 4 случай), это связано с анатомической особенностью кости, которая в некоторых участках тоньше, чем у мужчин. Так же, с наступлением менопаузы, на фоне резкого изменения гормонального баланса, у женщины активно вымывается кальций, и кости становятся хрупкими.</li>\r\n<li>Наличие в анамнезе сахарного диабета, артрита, остеопороза, рассеянного склероза и т.д.</li>\r\n<li>Слепые и плохо зрячие.</li>\r\n<li>Генетическая предрасположенность к костным патологиям.</li>\r\n<li>Люди, проходящие лечение диуретиками и антикоагулянтами.</li>\r\n<li>Алкоголики и наркоманы.</li>\r\n</ul>",
"pathogenesis": "<p>Под влиянием внешней силы, не превышающей пределов ее упругости, кость кратковременно деформируется и снова принимает свою первоначальную форму. Если же воздействующая внешняя сила превышает этот предел, целость кости нарушается. Давление на губчатую кость в продольном направлении вызывает ее сплющивание, при этом образуются компрессионные и вколоченные переломы (позвоночник). При действии скручивающей силы возникают винтообразные или спиральные. Дырчатые переломы - огнестрельные ранения.Переломы в зависимости от направления линии перелома к оси кости: поперечные; продольные; винтообразные; косые.</p>\r\n<p>Ряд переломов, возникающих при сходном механизме повреждения, имеющих одну и ту же морфологическую картину, называют типичными или классическими (перелом лучевой кости в типичном месте, перелом таза Мальгеня).</p>\r\n<p>Патологические переломы возникают самопроизвольно под влиянием незначительной травмы (или даже без всякой травмы) кости, измененной каким-либо предшествовавшим патологическим процессом, чаще всего деструктивным. Они бывают при доброкачественных и злокачественных новообразованиях кости, при остеодистрофии, фиброзной остеодисплазии, при метастазах в кость (рак молочной железы, легких, щитовидной железы). </p>",
"diagnostics": "<p>Диагноз перелома подтверждается по данным рентгенограммы тазобедренного сустава и бедренной кости. При развитии неполного перелома (трещины кости) рентгенограмма не позволяет увидеть какие-либо изменения. При этом рекомендовано проведение магнитно-резонансной томографии (МРТ). Если проведение МРТ противопоказано или невозможно в силу каких-либо сопутствующих заболеваний или состояния пациента, то назначается компьютерная томография (КТ).</p>",
"treatment": "<p>На сегодняшний день оперативное лечение — это основной метод терапии, позволяющий пациенту восстановиться за максимально короткий срок после получения травмы.</p>\r\n<p>Для внутрисуставных переломов такой способ лечения более приемлем, так как после операции, согласно статистике, сращивание костей происходит в 70% случаев. Операция противопоказана пациентам старческого возраста и имеющим определённые заболевания, наличие у них инфицированных ран.</p>\r\n<p>В сложных случаях, когда нет эффекта от консервативного лечения, а к оперативному вмешательству имеются противопоказания, применяются такие способы лечения:</p>\r\n<ul>\r\n<li>Остеосинтез;</li>\r\n<li>Вытяжение скелета;</li>\r\n<li>Эндопротезирование сустава.</li>\r\n</ul>\r\n<p>Способ остеосинтеза заключается в использовании специальных конструкций из металла для фиксации фрагментов кости, обеспечивающих их сращение. Этот метод лечения позволяет быстро добиться необходимой подвижности конечности пациента, как правило, спустя 6-10 недель.</p>\r\n<p>Вытяжение скелета используется, когда оперативное лечение невозможно по ряду причин. Осуществляется эта манипуляция при помощи шины Белера. Пациенту проводятся обезболивающие процедуры. Потом для вытяжения через большеберцовую кость продевается спица, закрепляемая на специальной скобе, к которой будет подвешен груз. Обычно груз весит 10 килограмм, но устанавливаемый вес зависит от тяжести повреждения и степени смещения. Больной укладывается на щит, а его конечность помещается на шину Белера. Вытяжением скелета занимаются до 12 недель, но иногда срок может сократиться вдвое. На повреждённую ногу накладывают повязку из гипса на срок около 5 месяцев. Недостатком такого лечения является долгое пребывание конечности в обездвиженном состоянии, что негативно сказывается на выполнении её основных функций в дальнейшем.</p>\r\n<p>Аппараты внешней фиксации признаны современной медициной ещё одним надёжным методом лечения при переломах. Показанием к их использованию служит имеющийся у пациента перелом бедра в области шейки.</p>\r\n<p>Своевременное тотальное эндопротезирование позволяет избежать серьёзных осложнений у пациента.</p>\r\n<p>При мыщелковых переломах бедра без смещения накладывают кокситную гипсовую повязку (от паха до лодыжек) на срок 4-8 недель. При смещении отломков перед наложением повязки выполняют их репозицию (сопоставление). </p>",
"prevention": "<p>Профилактика перелома бедренной кости состоит в проведении здорового и активного образа жизни, правильном питании, слежении за своим весом, своевременном обращении к врачу при первых симптомах болезней. Такого рода профилактика поддерживает здоровье в целом, укрепляет все системы в организме, включая костную систему.</p>",
"clinical_picture": "<p>Клиника переломов различных частей бедра протекает по-разному.</p>\r\n<p>Признаком перелома шейки бедра служат ощущения боли в тазобедренном суставе и области паха, которые становятся сильными при двигательной активности. Наблюдается некоторая деформация в тазобедренном суставе, небольшая отёчность повреждённого участка, отсутствие кровоподтёков.</p>\r\n<p>Если повреждение затрагивает вертельную область верхней части бедра, то симптомом её перелома является интенсивная боль, усиливающаяся при попытках движения травмированной ногой и ощупывания её. Для вертельного перелома характерны отёчность и кровоподтёки в области повреждения.</p>\r\n<p>Наиболее опасен чрезвертельный перелом. Его признаками являются выраженный отёк, боль и «симптом прилипшей пятки» (нельзя поднять прямую ногу вверх в положении лёжа).</p>\r\n<p>При переломе нижнего конца бедренной кости пациент предъявляет жалобы на резкую боль в колене и нижних отделах бедра. Движения в суставе ограничены и резко болезненны. Коленный сустав увеличен в объеме. Перелом наружного мыщелка сопровождается отклонением голени кнаружи. При переломе внутреннего мыщелка голень пациента отклоняется кнутри. </p>\r\n<p>Травма ноги со смещением считается более опасной, требующей долгого лечения. Для неё характерны следующие признаки:</p>\r\n<ul>\r\n<li>Деформация области травмированного участка сустава;</li>\r\n<li>Наличие резкой боли, возникающей при любом движении конечности;</li>\r\n<li>Появление отёка;</li>\r\n<li>Травмированная нога выглядит короче, чем здоровая;</li>\r\n<li>Кровоподтёки мягких тканей бедра;</li>\r\n<li>Повреждённая нога остаётся повёрнутой кнаружи на травмированной стороне.</li>\r\n</ul>\r\n<p>Перелом вколоченного вида признается по «симптому прилипшей пятки», постоянной боли в области таза, нарастающей по причине внутреннего кровоизлияния. Укорочение повреждённой ноги может не фиксироваться. Внутрисуставные разломы в покое проявляются слабой болью, но в движении она резко увеличивается.</p>",
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}
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