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},
"code": "G54",
"name": "Поражения нервных корешков и сплетений",
"icd_name": "Поражения нервных корешков и сплетений",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3
],
"periodicity": 1,
"slug": "g54_porazheniya_nervnyh_koreshkov_i_spleteniy",
"lead": "Нарушение здоровья, относящееся к группе поражения отдельных нервов, нервных корешков и сплетений",
"description": "Корешко́вый синдро́м (радикулопатия) — довольно частый невралгический синдром, включающий в себя комплекс симптомов и возникающий в результате сдавливания (компрессии) спинномозговых корешков (корешков спинномозговых нервов). \r\nПлексит (плексопатия) – это поражение нервного сплетения, образованного передними ветвями спинномозговых нервов. Различают шейный, плечевой и пояснично-крестцовый плекситы, причем чаще всего встречается плечевой плексит.",
"etiology": "<p>Причины развития корешкового синдрома:</p>\r\n<ul>\r\n<li>грыжа межпозвоночного диска (наиболее частая причина);</li>\r\n<li>хронический менингит (обычно вызывает множественное поражение корешков);</li>\r\n<li>эпидуральные абсцессы и опухоли;</li>\r\n<li>спинальные менингиомы и нейрофибромы;</li>\r\n<li>радикулопатия при сахарном диабете, поражающая грудные корешки и корешки, иннервируюшие конечности;</li>\r\n<li>костные изменения при ревматоидном артрите или остеоартрите, особенно на шейном и поясничном уровнях, могут приводить к сдавлению отдельных корешков.</li>\r\n<li>опоясывающий лишай (обычно вызывает радикулопатию с выраженной болью и нарушением чувствительности в соответствующем дерматоме, а также с характерной сыпью).</li>\r\n</ul>\r\n<p>Причинами развития поражения сплетений являются:</p>\r\n<ul>\r\n<li>переохлаждение,</li>\r\n<li>любая травма (профессиональная, спортивная, вследствие повышенной физической нагрузки),</li>\r\n<li>некоторые инфекции,</li>\r\n<li>сдавление новообразованием или при деформации любых тканей,</li>\r\n<li>такие заболевания как остеохондроз, подагра, сахарный диабет.</li>\r\n</ul>\r\n<p> </p>\r\n<p> </p>",
"pathogenesis": "<p>Радикулопатия вызывается компрессией или раздражением нервов в области их выхода из позвоночного столба. Это может быть следствием механической компрессии нервного корешка грыжей межпозвонкового диска, костными разрастаниями (остеофитами) при спондилезе или утолщёнными близлежащими связками.</p>\r\n<p>Другими менее частыми причинами механической компрессии нервного корешка могут быть опухоли или инфекции. Все вышеперечисленные образования уменьшают пространство спинномозгового канала, что приводит к защемлению выходящего нерва.</p>\r\n<p>Сколиоз может вызвать защемление нерва с одной стороны позвоночника из-за его аномального изгиба.</p>\r\n<p>Другие причины радикулопатии включают диабет, который может замедлить нормальный приток крови к спинномозговым нервам, а также воспаление в результате травмы или дегенеративного процесса в позвоночнике.</p>\r\n<p>Холод, инфекционное поражение, сдавление нервных волокон при переломах и травмах приводят к отеку волокон, образующих нервные сплетения, и к нарушению всех их функций. Патогенез плексита проходит две стадии: невралгическую и паралитическую. Соответственно для каждой стадии характерны свои клинические проявления. При развитии невралгической стадии на первое место выходит болевой синдром. При прогрессировании патологического процесса и развитии паралитической формы присоединяется снижение мышечной силы плеча.</p>",
"diagnostics": "<ul>\r\n<li>Неврологический осмотр: оценка силы мышц рук, ног, шеи, состояния ногтей и кожи, оценка рефлексов (при плекситах рефлексы снижены) и тонуса мышц (при плекситах снижен). </li>\r\n<li>Анализ крови: возможно выявление признаков воспаления (увеличение количества лейкоцитов (белых клеток крови), увеличение скорости оседания эритроцитов (красных кровяных клеток)), особенно при инфекционной природе заболевания. </li>\r\n<li>Электронейромиография: метод позволяет оценить скорость проведения импульса по нервным волокнам и определить признаки повреждения нервов или нервных сплетений. </li>\r\n<li>КТ (компьютерная томография) и МРТ (магнитно-резонансная томография) шеи (при подозрении на шейный плексит), руки (при подозрении на плечевой плексит) или поясницы и живота (при подозрении на пояснично-крестцовый плексит): позволяет послойно изучить строение перечисленных областей и выявить какие-либо изменения, способные привести к нарушению функции сплетения (травмы, отек, опухоли).</li>\r\n</ul>\r\n<p>Стандартный инструментальный метод диагностики корешкового синдрома включают рентгенографию позвоночника в передней и боковой проекциях. На сегодня самым чувствительным и информативным методом диагностики патологии позвоночника является магнитно-резонансная томография (МРТ). Однако при установке диагноза «корешковый синдром» важную роль играют клинические симптомы.</p>",
"treatment": "<p>Лечение плекситов всегда должно быть направлено на устранение причины воспаления нервного сплетения:</p>\r\n<ul>\r\n<li>антибактериальные и противовирусные препараты при инфекционной природе плексита;</li>\r\n<li>хирургическое лечение при травматическом или компрессионном плексите, когда имеют место кровяные сгустки или опухолевые образования вокруг сплетения, сдавливающие его;</li>\r\n<li>нормализация уровня глюкозы в крови с помощью гипогликемических средств и снижение уровня мочевой кислоты в крови с помощью гипоурикемических средств при дисметаболических плекситах. </li>\r\n</ul>\r\n<p>При любой природе плексита также проводится следующее лечение:</p>\r\n<ul>\r\n<li>обезболивающие препараты (анальгетики);</li>\r\n<li>витаминотерапия (группы В, А, С);</li>\r\n<li>физиолечение — ультравысокочастотные токи, магнитотерапия;</li>\r\n<li>лечебная физкультура — комплекс упражнений, способствующих восстановлению поврежденных нервных волокон.</li>\r\n</ul>\r\n<p>Основные принципы лечения корешкового синдрома включают лечебную физкультуру, приём нестероидных противовоспалительных средств и местных раздражителей. При выраженном спазме мышцы применяют миорелаксанты, средства для улучшения микроциркуляции — дезагреганты. При недостаточном эффекте медикаментозного лечения применяют лечебные блокады: внутрикостные блокады, паравертебральные блокады, блокады фасеточных суставов и эпидуральные блокады. Назначение антиконвульсантов и антидепрессантов — по показаниям.</p>\r\n<p>Медикаментозные меры заключаются также в назначении витаминов группы В, хондропротекторов, НПВС для наружного применения.</p>\r\n<p>В отдельных случаях для лечения корешкового синдрома показано хирургическое вмешательство.</p>\r\n<p>В лечении используют рефлексотерапию, мануальное воздействие, физиотерапию (электрофорез, фонофорез), массаж, лечебную гимнастику, диету (направленную на снижение веса и выведение солей).</p>\r\n<p> </p>",
"prevention": "<p>Профилактика плексита</p>\r\n<ul>\r\n<li>Ношение теплой одежды зимой.</li>\r\n<li>Сбалансированное и рациональное питание (употребление в пищу продуктов с высоким содержанием клетчатки (овощи, фрукты, зелень), отказ от консервированной, жареной, острой и горячей пищи). </li>\r\n<li>Частое дробное питание (5-6 раз в день небольшими порциями).</li>\r\n<li>Своевременное лечение инфекционных процессов (возможно с применением антибактериальных и противовирусных препаратов).</li>\r\n</ul>\r\n<p>Меры профилактики развития корешкового синдрома включают первичную профилактику дегенеративных процессов в позвоночнике, укрепление мышечного каркаса спины с помощью лечебной физкультуры и массажа, а также нормализация веса.</p>",
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}
]
}
