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"code": "M41",
"name": "Сколиоз",
"icd_name": "Сколиоз",
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"cause": [
3,
0
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"periodicity": 4,
"slug": "m41_skolioz",
"lead": "Нарушение здоровья, относящееся к группе деформирующие дорсопатии",
"description": "Сколиоз — это искривление позвоночника вправо или влево относительно своей оси. Чаще всего встречаются сколиозы грудного и поясничного отделов позвоночника.",
"etiology": "<p>В основе врожденных сколиозов лежат аномалии развития позвоночника онтогенетического значения. К ним относят сколиозы на почве клиновидных позвонков, добавочных клиновидных позвонков, асимметричный сколиоз тел позвонков, сколиоз вследствие синостоза поперечных отростков, дуг, ребер и др.</p>\r\n<p>Примерно в 80 % всех случаев приобретенного причина возникновения искривлений неизвестна (идиопатический сколиоз)</p>\r\n<p>Оставшиеся 20 % сколиозов возникают вследствие перенесенного полиомиелита или травмы позвоночника и спинного мозга (паралитический сколиоз); дегенеративно-дистрофических заболеваний позвоночника или других неврологических заболеваний (неврогенный сколиоз); в результате перенесенных тяжелых ожогов и хирургических вмешательств на органах грудной клетки (рубцовый сколиоз).</p>",
"pathogenesis": "<p>Основные патологические звенья развития идиопатического сколиоза – патологическая ротация (вращение) позвонков в горизонтальной плоскости, смещение в сторону центральной части межпозвоночного диска (пульпозного ядра) позвонка, фронтальный наклон позвоночника и поворот позвонков вокруг вертикальной оси позвоночника (торсия).</p>",
"diagnostics": "<p>В ранних стадиях искривления выявляются лучше всего тестом «в наклоне». При этом пациент наклоняется вперёд со свободно опущенными руками. Проверяющий смотрит сзади на позвоночник и отмечает асимметрию — выступающее ребро, возвышающиеся с одной стороны ребра или лопатку, искривления позвоночника.</p>\r\n<p>Основным методом диагностики является рентгенологическое исследование. Рентгенографию позвоночника проводят в прямой и боковой проекциях, в положении стоя. По рентгенологическому снимку определяют локализацию дуги искривления, измеряют ее величину, степень патологической ротации, форму и структуру тел позвонков и межпозвоночных дисков, выявляют диспластические признаки развития костной ткани, оценивают степень остеопороза, костный возраст для определения прогноза дальнейшего течения заболевания.</p>\r\n<p>Рентгенофункциональное исследование проводят для определения стабильности или мобильности деформации.</p>",
"treatment": "<p>Консервативное лечение</p>\r\n<p>Цель консервативного лечения – удержать деформацию позвоночника от дальнейшего прогрессирования. Принципы лечения: осевая разгрузка позвоночника и создание крепеого мышечного корсета за счет использования физических методов лечения. Лечебную гимнастику – специальный комплекс упражнений, соответствующий индивидуальному диагнозу, выполняются сначала амбулаторно, а затем дома по 30-40 мин. Назначают массаж мышц спины и живота (2-3 курса по 15 сеансов). Рекомендуют регулярное плавание стилем «брасс».</p>\r\n<p>Физиотерапевтическое лечение включает электрофорез лекарственных средств для улучшения трофики (питания) спинного мозга, костной и околопозвоночных мягких тканей в области основной дуги искривления, электромиостимуляцию на выпуклой стороне деформации. Для разгрузки позвоночника, когда это необходимо, можно применять готовые ортопедические корсеты.</p>\r\n<p>Медикаментозное лечение: препараты кальция, поливитамины.</p>\r\n<p>Хирургическое лечение</p>\r\n<p>Операция при сколиозе представляет собой выпрямление позвоночника до определенного угла с использованием металлических конструкций. При этом подвергшийся оперативному вмешательству отдел позвоночника обездвиживается. Для фиксации позвоночника применяются специальные пластины, стержни, крючки и винты. Для расширения позвонков, придания позвоночнику более правильной формы и улучшения консолидации используются костные трансплантаты в виде вкладышей. </p>",
"prevention": "<p>Специфической профилактики не существует.</p>\r\n<p>Профилактика сколиоза должна занимать у родителей важное место. Нужно следить за тем, чтобы выполнялись следующие основные правила:</p>\r\n<ul>\r\n<li>Не сажать грудного ребенка раньше того момента, когда он сам сможет это сделать.</li>\r\n<li>Профилактика сколиоза у новорожденных предусматривает сон на специальном ортопедическом матрасе.</li>\r\n<li>Следите за тем, чтобы у ребенка была правильная осанка, и он не сутулился.</li>\r\n<li>Правильно оборудованное рабочее место школьника согласно его возрасту и росту. Расстояние между столом и глазами не должно быть менее 30 см.</li>\r\n<li>Портфель или рюкзак должен быть с двумя лямками и не очень тяжелым.</li>\r\n<li>Достаточная физическая активность.</li>\r\n</ul>\r\n<p>Подвижный образ жизни, правильное питание и поддержание осанки являются профилактикой искривлений позвоночника у взрослых.</p>",
"clinical_picture": "<p>На начальных стадиях сколиоз протекает бессимптомно, поэтому следует обращать внимание на следующие признаки:</p>\r\n<ul>\r\n<li>Одно плечо стоит выше другого.</li>\r\n<li>Когда ребенок стоит, прижав руки к бокам, расстояние между рукой и талией различается с двух сторон.</li>\r\n<li>Лопатки расположены несимметрично – на вогнутой стороне лопатка находится ближе к позвоночнику, ее угол выпирает.</li>\r\n<li>При наклоне кпереди становится заметным искривление позвоночника.</li>\r\n</ul>\r\n<p>Классификация сколиоза включает в себя 4 степени:</p>\r\n<p>1 степень – угол до 10 градусов. Определяются следующие клинические признаки: сутуловатость, опущенная голова, асимметричная талия, разная высота надплечий.</p>\r\n<p>2 степень – угол от 11 до 25 градусов. Выявляется кривизна позвоночника, не исчезающая при смене положения тела. Половина таза на стороне искривления опущена, треугольник талии и контуры шеи ассиметричны, в грудном отделе на стороне искривления имеется выпячивание, в поясничном – мышечный валик.</p>\r\n<p>3 степень – угол от 26 до 50 градусов. В дополнение ко всем признакам сколиоза, характерным для 2 степени, становятся заметными выпирающие передние реберные дуги и четко очерченный реберный горб. Мышцы живота ослаблены. Наблюдаются мышечные контрактуры и западание ребер.</p>\r\n<p>4 степень – угол более 50 градусов. Резкая деформация позвоночника, все выше перечисленные признаки усилены. Значительное растяжение мышц в области искривления, реберный горб, западание ребер в зоне вогнутости.</p>",
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"image_alt": null,
"standard_type": 3,
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"published": 2,
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"block_rubric": 135,
"standards": [
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"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;\">Патология относится к группе деформаций, возникающих в период роста (то есть, в детстве и юности). На первом месте по распространенности с большим отрывом находится идиопатический сколиоз – то есть, сколиоз с неустановленной причиной. Он составляет около 80% от общего числа случаев. При этом девочки болеют сколиозом в 4-7 раз чаще мальчиков. В оставшихся 20% случаев наиболее часто выявляется сколиоз вследствие врожденных деформаций позвоночника, обменных нарушений, заболеваний соединительной ткани, тяжелых травм и ампутаций конечностей, а также значительной разницы в длине ног.</span></p>",
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"diagnostics": "<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;\">Рентгенография в двух проекциях является основным эффективным методом диагностики патологий позвоночника. В особо сложных случаях необходимо проведение МРТ или КТ. По снимкам врач ставит окончательный диагноз, определяет степень сколиоза. Часто специалист может предположить наличие деформации позвоночника даже визуально при осмотре больного, но предварительный диагноз всегда подтверждается рентгеном.</span></p>",
"treatment": "<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;\">В зависимости от причины сколиоза предусматривают различные лечебные мероприятия. При врожденном сколиозе лечение зависит от степени поражения позвоночника. Для предупреждения быстрого прогрессирования заболевания применяют оперативное вмешательство. При этом последующее лечение заключается в равномерном распределении нагрузки на позвоночник в целом. Консервативное лечение направлено на формирование правильной осанки и восстановление правильного дыхания. Необходимы общеукрепляющие процедуры, занятия лечебной физкультурой (ЛФК), массаж и плавание. Очень часто врач назначает ношение корсета. При приобретенном сколиозе первой или второй степени основу лечения также составляют ЛФК, массаж и плавание. При мышечной слабости врач может назначить электромиостимуляцию. В последние годы широкое распространение получила кинезиотерапия. Она позволяет лечить посредством движения и располагает большими возможностями, нежели ЛФК. Кинезиотерапия может быть показана подросткам до окончания роста и на этапе использования корсета при искривлении не более 25 градусов. Кроме того, она применяется в период подготовки к хирургическому лечению и в восстановительный послеоперационный период. Консервативное лекарственное лечение зависит от симптомов заболевания. При болях назначают нестероидные противовоспалительные препараты и лишь в случае их неэффективности – блокады с местноанестезирующими средствами. </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;\">Как и многие другие заболевания, сколиоз легче предотвратить, чем вылечить. Для этого нужно уделить внимание:</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;\">Грамотной организации рабочего и спального места.</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;\">Равномерной нагрузке на спину при ношении сумок, рюкзаков.</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;\">Поддержанию ровной осанки.</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;\">Ношению ортопедической и удобной обуви.</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;\">Систематическим занятиям спортом – подойдут плавание, лечебная гимнастика, игровые виды спорта. Осторожность нужна в отношении тех видов спорта, которые оказывают несимметричную нагрузку на тело (например, теннис), вызывают сотрясение позвоночника (прыжки), большие нагрузки (тяжелая атлетика), требуют постоянного растяжения или скручивания позвоночника ( гимнастика).</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;\">Здоровому питанию для обеспечения костной и хрящевой тканей необходимыми питательными веществами.</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\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </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;\">Пациенты со сколиозом предъявляют жалобы на боли в области спины, головные боли, усталость при длительной статической нагрузке, слабость. При осмотре четко выражены нарушение осанки, асимметрия углов лопаток, плеч и боковое искривление позвоночника. При искривлении в грудном отделе позвоночника с противоположной стороны в поясничном отделе появляется мышечный валик, который особенно хорошо заметен при наклоне туловища. Из-за нарушения структуры позвонков возможно защемление нервных корешков, что вызывает появление онемения в конечностях, боли. Особенно часто неврологические расстройства (нарушение чувствительности в определенных зонах, синюшность пальцев, искривление пальцев стопы, недержание мочи, сосудистые расстройства) сопровождают диспластический сколиоз.</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;\">Чем в более раннем возрасте проявилось заболевание, тем сильнее его склонность к прогрессированию.</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;\">Максимального развития сколиоз достигает у девочек в 11-13 лет, у мальчиков – в 14-16 лет. Затем процесс замедляется и прекращается с окончанием роста костей – примерно к 20 годам. Сколиоз может сопровождаться формированием нескольких дуг искривления. В этих случаях говорят о сложном сколиозе – двойном или тройном.</span></p>",
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"lead": "Зрачковый рефлекс заключается в содружественном и равном сужении зрачков при освещении одного из глаз, обеспечивая при этом уменьшение светового потока, падающего на сетчатку. Сужение зрачка выявляется при исключительно низкой интенсивности освещения и пропорционально интенсивности и продолжительности стимула.\r\nПричинами нарушений зрачковых реакций являются:\r\nПоражения зрительного нерва. Слепой глаз не отвечает на прямой свет при его изолированном освещении и при этом нет содружественного сокращения сфинктера другого глаза, но слепой глаз отвечает содружественной реакцией, если его III нерв интактен и если другой глаз и его зрительный нерв не повреждены.\r\nПоражения глазодвигательного нерва. При повреждении III нерва прямая и содружественная реакция на свет отсутствует на поражённой стороне из-за паралича сфинктера зрачка, но прямая и содружественная реакция остаются сохранными на противоположной стороне.\r\nДругими причинами являются:\r\nСиндром Эди.\r\nНеобходимо отметить особый тип зрачковых нарушений, когда имеется паралич зрачковых рефлексов с отсутствием реакций на свет, но сохраненной реакцией на конвергенцию. Эта патология описана при различных состояниях: нейросифилис, синдром Эди, сахарный диабет, пинеалома, патологическая регенерация после поражения глазодвигательного нерва, энцефалиты, рассеянный склероз, офтальмический герпес, травма глаза, дистрофическая миотония, пандизавтономия (семейная вегетативная дисфункциия синдром Райли-Дея), синдром Фишера, I тип НМСН (болезнь Шарко-Мари-Тута).",
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"lead": "Зрачковый рефлекс заключается в содружественном и равном сужении зрачков при освещении одного из глаз, обеспечивая при этом уменьшение светового потока, падающего на сетчатку. Сужение зрачка выявляется при исключительно низкой интенсивности освещения и пропорционально интенсивности и продолжительности стимула.\r\nПричинами нарушений зрачковых реакций являются:\r\nПоражения зрительного нерва. Слепой глаз не отвечает на прямой свет при его изолированном освещении и при этом нет содружественного сокращения сфинктера другого глаза, но слепой глаз отвечает содружественной реакцией, если его III нерв интактен и если другой глаз и его зрительный нерв не повреждены.\r\nПоражения глазодвигательного нерва. При повреждении III нерва прямая и содружественная реакция на свет отсутствует на поражённой стороне из-за паралича сфинктера зрачка, но прямая и содружественная реакция остаются сохранными на противоположной стороне.\r\nДругими причинами являются:\r\nСиндром Эди.\r\nНеобходимо отметить особый тип зрачковых нарушений, когда имеется паралич зрачковых рефлексов с отсутствием реакций на свет, но сохраненной реакцией на конвергенцию. Эта патология описана при различных состояниях: нейросифилис, синдром Эди, сахарный диабет, пинеалома, патологическая регенерация после поражения глазодвигательного нерва, энцефалиты, рассеянный склероз, офтальмический герпес, травма глаза, дистрофическая миотония, пандизавтономия (семейная вегетативная дисфункциия синдром Райли-Дея), синдром Фишера, I тип НМСН (болезнь Шарко-Мари-Тута).",
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"lead": "Выделения из глаз - появление различного по характеру отделяемого из конъюнктивального мешка или непосредственно со слизистой оболочки глазного яблока. В целом появление выделений из глаз является защитной реакцией организма: с их помощью глаза очищаются от пыли, микроорганизмов, аллергенов, мелких инородных частиц и пр. Сами по себе глазные выделения не опасны, однако в некоторых случаях они могут свидетельствовать о более серьезной патологии глаз, требующей активного лечения.Основными причинами появления глазных выделений являются:\r\n\r\nиндивидуальная аллергическая реакция\r\nвоспаление слизистой оболочки глаза (конъюнктивит) или век (блефарит)\r\nнекоторые процессы, не связанные с инфекцией (например, синдром сухого глаза) \r\nВ зависимости от причины, характер выделений из глаз бывает различным. Так, бактериальное или вирусное воспаление глаз обычно сопровождается появлением обильного, вязкого отделяемого, нередко имеющего вид мутной слизи или корочек в уголках глаз. Указанные симптомы требуют немедленного обращения за квалифицированной медицинской помощью, поскольку без лечения конъюнктивит прогрессирует, и состояние больного стремительно ухудшается. Следует иметь в виду, что конъюнктивит нередко заразен для окружающих больного людей, особенно восприимчивы к инфекции дети. Инфекция передается через пользование общими полотенцами, подушками, при посещении бассейна. В то же время, правильно назначенное лечение быстро ликвидирует симптомы воспаления глаз.\r\n\r\nВыделения из глаз аллергического характера обильны и могут напоминать слезотечение. Помимо этого, больных беспокоит зуд, а также отек и выраженное покраснение слизистой оболочки глаз. При применении антигистаминных препаратов (в виде таблеток или глазных капель), а также в случае прекращения контакта с аллергеном подобные выделения из глаз быстро исчезают. \r\n\r\nВоспаление век (блефарит) также сопровождается появлением отделяемого из глаз. Среди причин, которые могут вызвать развитие блефарита, следует упомянуть инфекции (как следствие нарушения гигиены, на фоне ослабления иммунитета, при избыточной продукции кожного жира), заражение демодексом. Нередко выделения из глаз при блефарите имеют вид сухих корочек или чешуек, расположенных по краям век, сами веки при этом могут быть отечными. Для исключения заражения демодексом необходимо будет пройти специальное обследование. Блефарит – не самое простое в плане лечения заболевание глаз, оно требует длительного целенаправленного комплексного лечения. При отсутствии адекватной терапии блефарит может привести к ухудшению зрения и деформации век. \r\n\r\nКакой бы ни была причина появления выделений из глаз, следует обязательно обратиться к врачу для обследования и назначения соответствующего лечения. Самолечение очень часто может быть не только неэффективным, но и привести к ухудшению состояния больного.\r\n\r\nВрачи нашей клиники проведут тщательное обследование для выявления причин появления выделений из глаз и назначат лечение, которое поможет быстро улучшить состояние пациента. Помните: только правильно подобранное лечение позволяет полностью избавиться от выделений из глаз и избежать появления осложнений.",
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