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},
"code": "B72",
"name": "Дракункулез",
"icd_name": "Дракункулез",
"gender": 1,
"age_min": 0,
"age_max": 100,
"cause": [
2,
5,
7
],
"periodicity": 1,
"slug": "b72_drakunkulez",
"lead": " Гельминтоз из группы нематодозов, вызываемый самками круглых червей Dracunculus medinensis.",
"description": "Инфекционное заболевание.",
"etiology": "<p align=\"justify\">Ришта, или Dracunculus medinensis является круглым гельминтом (нематодой) нитевидной формы. Самки червя достигают длины 30-120 см, самцы - 12-30 мм. Взрослые особи паразитируют в организме человека, реже - животных (хищников, обезьян, собак, кошек). Самки ришты отрождают личинок, которые заглатываются пресноводными рачками-циклопами, выступающими промежуточными хозяевами гельминта. В организме циклопов личинки претерпевают линьку и через 4-14 суток достигают инвазивной стадии.</p>\r\n<p align=\"justify\">Заражение человека дракункулезом происходит при заглатывании воды, содержащей инвазированных циклопов</p>",
"pathogenesis": "<p align=\"justify\">В ЖКТ окончательного хозяина зрелые личинки (микрофилярии) проникают через кишечную стенку и мигрируют по мягким тканям в межмышечное пространство. Здесь через 3-4 месяцев паразиты достигают половой зрелости. После оплодотворения самцы возбудителя дракункулеза погибают (обызвествляются в мягких тканях или рассасываются), а самка продолжает расти и мигрирует в подкожную клетчатку. Достигнув своим головным концом кожного покрова, самка выделяет специальный секрет, под действием которого на коже человека образуется псевдофурункул, а затем происходит разрыв кожи. Через дефект кожных покровов выпячивается матка гельминта; при соприкосновении с водой она разрывается, и наружу выходит тканевой <a title=\"Перейти на страницу симптома Выпот\" href=\"../../../symptom/vypot/\">экссудат</a>, содержащий мелкие личинки паразита. Одна самка выделяет в водную среду до 3 млн. личинок, после чего погибает.</p>\r\n<full></full>\r\n<p align=\"justify\">Длительность паразитирования ришты в теле человека может достигать 18 месяцев. Попав в воду, личинки заглатываются циклопами – так начинается новый цикл развития гельминта. Дракункулезом чаще болеют мужчины различных возрастных групп; женщины и дети младшего возраста заражаются реже. Обычно у человека развивается инвазия одним гельминтом, однако описаны случаи множественного дракункулеза с одновременным паразитированием 17 и даже 50 гельминтов. Заболеваемости дракункулезом способствует антисанитария, отсутствие водопровода и канализации, употребление сырой воды из открытых водоисточников. Загрязнение водоемов личинками гельминта может происходить при заборе воды, купании, ритуальных омовениях. Патогенные эффекты при дракункулезе обусловлены сенсибилизацией организма продуктами жизнедеятельности паразита, механическим травмированием тканей и наслоением вторичной инфекции.</p>",
"diagnostics": "<p>В эндемичных районах заподозрить дракункулез у больных позволяют характерные кожные проявления, пальпация под кожей шнуровидного образования, обнаружение на месте разрыва волдыря переднего конца ришты. При помещении гельминта в воду происходит выделение личинок, которых можно рассмотреть при микроскопии. Также обнаружить личинки ришты можно в отделяемом из вскрывшихся пузырей. Обызвествленные паразиты могут выявляться при рентгенологическом исследовании тканей. С целью подтверждения диагноза дракункулеза возможно проведение внутрикожной аллергической пробы, серологических исследований (РНИФ). Клинические проявления дракункулеза необходимо отличать от фурункула, абсцесса, флегмоны.</p>",
"treatment": "",
"prevention": "<p>После появления гельминта из-под кожи извлечь его можно путем наматывания на марлевый валик или палочку. Во избежание обрыва гельминта делать это следует осторожно и постепенно, прекращая извлечение при появлении ощущения сопротивления. Обычно за один прием удается извлечь 5-10 см нитевидного паразита - в этом случае процедуру повторяют на следующий день. При обрыве гельминта производится его хирургическое удаление. Предварительное проведение курса противогельминтной терапии при дракункулезе препаратами метронидазол, ниридазол, амбильгар, минтезол облегчает извлечение погибшего паразита. Также показано назначение антигистаминных, кортикостероидных, а при бактериальных осложнениях - противомикробных препаратов. Заболевшим дракункулезом вводится противостолбнячный анатоксин.</p>",
"clinical_picture": "<p align=\"justify\">бычно дракункулез заявляет о себе развитием аллергических реакций (крапивницы, кожного зуда, приступов удушья, одутловатости лица), головокружения, тошноты, рвоты, лихорадки. Отмечаются локальные отеки мягких тканей в месте расположения гельминта, припухание суставов, регионарный лимфаденит.</p>\r\n<full></full>\r\n<p align=\"justify\">Через 8-10 дней после развития общей симптоматики в месте будущего выхода самки ришты на поверхности кожи появляется <a title=\"Перейти на страницу симптома Покраснение кожи\" href=\"../../../symptom/pokrasnenie_kozhi/\">эритема</a> и плотный инфильтрат, из которого затем формируется волдырь. Этот пузырь заполнен желтоватой жидкостью, содержащей лейкоциты, эозинофилы и личинки гельминта. Через несколько дней пузырь вскрывается с отторжением некротических масс и образованием язвы. Из-под кожи появляется головной конец самки паразита. Эти процессы сопровождаются нестерпимым зудом и жгучей болью, которые немного стихают после контакта с холодной водой. Именно этот факт заставляет больных дракункулезом искать спасения от мучительных симптомов, окунаясь в водоемы. При погружении пораженных частей тела в воду происходит массовый выход личинок и обсеменение водоема.</p>\r\n<p align=\"justify\">Излюбленная локализация ришт – подкожная клетчатка нижних конечностей (голеней, лодыжек), реже - верхних конечностей, живота, спины, ягодиц, мошонки, молочных желез и других участков тела. При неосложненной форме дракункулеза язвенный дефект кожи быстро заживает. Если в организме паразитирует единственный гельминт, то через 4-6 недель клинические проявления дракункулеза стихают, и заболевание заканчивается выздоровлением.</p>",
"image": null,
"image_alt": null,
"standard_type": 1,
"danger": 6,
"published": 1,
"parent": null,
"block_rubric": 17,
"standards": []
},
{
"id": 12522,
"symptoms": [
{
"id": 2848,
"synonyms": [
{
"name": "мышечная боль"
},
{
"name": "боль в мышцах"
},
{
"name": "мышцы болят"
},
{
"name": "Миалгия"
},
{
"name": "ломота"
},
{
"name": "боль в мышцах рук"
},
{
"name": "боль в мышцах ног"
},
{
"name": "боль в мышцах после тренировки"
},
{
"name": "боль в мышцах спины"
},
{
"name": "боль икроножная"
}
],
"body_points": [
{
"x": 265,
"y": 3325,
"r": 0
}
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"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;\">По мнению специалистов, ведущей причиной широкой распространенности дорсопатий является изменение образа жизни, связанное с автоматизацией, снижением среднего уровня физической активности, узкой специализацией, обуславливающей наличие однообразных нефизиологических нагрузок на костно-мышечную систему. Факторами, способствующими развитию дорсопатий, 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;\">Особенности обучения. Продолжительное пребывание в сидячем положении в процессе школьного обучения может стать причиной изменений мышечного тонуса, формирования нарушений осанки, сколиоза, плоской спины, патологического кифоза, лордоза.</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;\">Малоподвижность. Повсеместное использование механических транспортных средств, интернета, мобильных телефонов, широкое распространение офисных профессий влекут за собой снижение физических нагрузок, детренированность, на фоне которой чаще возникают травмы, развиваются дегенеративные заболевания.</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;\">Производственные факторы. Длительное сохранение статической позы, чрезмерные нагрузки на определенные группы мышц, вибрация, работа в условиях низких температур и повышенной влажности оказывают негативное влияние на опорно-двигательный аппарат, способствуют перенапряжению мышц, формированию воспалительных, дегенеративных патологий.</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;\">Психоэмоциональное напряжение. Постоянные стрессовые воздействия вызывают напряжение отдельных групп мышц, изменение мышечного тонуса, двигательных стереотипов. Хроническим стрессам особенно подвержены руководители, преподаватели, врачи, представители силовых, финансовых структур.</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;\">Избыточный вес. Нагрузка на позвоночник возрастает пропорционально увеличению массы тела, поэтому люди с лишним весом страдают от перегрузок даже в условиях умеренной активности. Ситуация усугубляется склонностью к гиподинамии, обусловленной плохой переносимостью физических нагрузок.</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;\">Наследственность. Существует наследственная предрасположенность к некоторым заболеваниям костей, мышц, суставов и связок, а также передающаяся по наследству слабость соединительной ткани, создающая благоприятные условия для развития патологий опорно-двигательной системы.</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 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;\">Другими предрасполагающими обстоятельствами считаются плоскостопие, заболевания нижних конечностей, сопровождающиеся нарушением физиологических механизмов стояния и ходьбы. Патология нередко провоцируется неправильным поднятием тяжестей. У женщин определенную роль играет беременность. Исследователи отмечают значение курения, нерационального питания, злоупотребления алкоголем.</span></p>\r\n<p><span id=\"docs-internal-guid-d21ed7df-7fff-f901-d72d-1b0b00c94e5a\"> </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;\">Наиболее часто (90%) дорсопатия обусловлена рефлекторным синдромом, который развивается при раздражении болевых рецепторов на фоне воспаления, смещения, перенапряжения, другого воздействия. В ответ на раздражение возникает спазм мышц, становящийся источником дополнительной болевой импульсации. Формируется порочный круг «боль – спазм – усиление боли».</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;\">У 10% пациентов причиной дорсопатии является сдавление спинного мозга, нервных корешков или позвоночной артерии. Компрессия провоцируется воспалением, травматическим повреждением, костными разрастаниями, нарушением нормальных анатомических соотношений между различными структурами позвоночного столба, образованием грыжевого выпячивания.</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;\">Раздражение болевых рецепторов при рефлекторном синдроме или компрессии нервных структур приводит к развитию асептического воспаления. С рецепторов сигналы передаются в головной мозг, который активирует продукцию противовоспалительных соединений в синапсах. Это стимулирует соседние нейроны, ядра таламуса, синтез цитокинов в нервных окончаниях. На фоне воспалительного процесса аксоны замещаются коллагеновыми волокнами, воспаление приобретает хронический характер.</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;\">Классическим подходом к первичной диагностике дорсопатии 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;\">сбор жалоб и анализ анамнестических данных пациента;</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;\">нейроортопедическое обследование (мануальная диагностика);</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;\">нейровизуализационные методы (рентгенография, МРТ пояснично-крестцового 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;\">нейрофизиологические исследования (стимуляционная, игольчатая электромиография; мигательный рефлекс; Н-рефлекс; соматосенсорные вызванные потенциалы и др.);</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;\">использование шкал, тестов и опросников (визуальная аналоговая шкала, индекс мышечного синдрома, Освестровский опросник при болях внизу спины, опросник Роланда–Морриса; шкала пятибалльной оценки вертеброневрологической симптоматики; самооценка уровня тревожности Спилбергера–Ханина; шестибалльная оценка мышечной силы; опросники нейропатической боли DN4 и PainDETECT и многие другие).</span></li>\r\n</ul>\r\n<p> </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;\">Консервативная терапия</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;\">Лечение этой группы патологий чаще консервативное, как правило, осуществляется в амбулаторных условиях. Основными принципами терапии дорсопатий являются раннее начало, комплексный подход, мероприятия, направленные на устранение болевого синдрома, сочетание симптоматических и патогенетических методик. Консервативное лечение дорсопатий включает следующие медикаментозные и немедикаментозные методы:</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;\">НПВС. Назначаются короткими курсами перорально, реже внутримышечно в период обострения для снижения интенсивности болевого синдрома, уменьшения воспаления. При необходимости могут длительно использоваться в виде местных средств.</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. Рекомендуются для уменьшения интенсивности мышечных спазмов, устранения рефлексогенного компонента болевого синдрома.</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 с кортикостероидами. Показаны при сильных болях, которые не устраняются другими препаратами. Бетаметазон, дексаметазон, другие средства вместе с местным анестетиком вводят в зону поражения.</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;\">Медикаменты для стимуляции восстановления. Для стимуляции репарации, активизации биохимических процессов в нервной ткани, восстановления хрящей применяют витамины группы В, хондропротекторы, анаболические, сосудистые препараты.</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;\">Успокоительные средства. Для профилактики депрессивных расстройств используют травяные сборы, мягкие транквилизаторы, антидепрессанты. Лекарства данных групп также уменьшают выраженность психогенных мышечных спазмов.</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;\">Тракционная терапия. Сухое и подводное вытяжение способствует расслаблению мышц, увеличению расстояния между позвонками. Устраняет компрессию нервов и сосудов, снижает выраженность болей, улучшает кровоснабжение.</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;\">Физиотерапия. Пациентам назначаются электрофорез, магнитотерапия, лазеротерапия, диадинамические токи, УФО, грязевые аппликации, подводный душ.</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;\">Другие методы. Обязательной частью реабилитации являются индивидуальные комплексы лечебной физкультуры. Широко применяется массаж. По показаниям используются иглотерапия, мануальная терапия, тейпирование.</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 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\"><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 пораженного отдела рекомендуют ортезы. При нестерпимых стреляющих болях назначают антиконвульсанты. Пациенты находятся на диспансерном наблюдении у врача-невролога. Для предупреждения обострений курсы лечения регулярно повторяют. В период ремиссии больных направляют на санаторно-курортное лечение.</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;\">Хирургическое лечение</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;\">Абсолютным показанием к операции считается сдавление конского хвоста с нарушениями функции тазовых органов, потерей чувствительности аногенитальной зоны, парезом стоп. В качестве относительного показания рассматривается неэффективность консервативной терапии в течение 6 месяцев. С учетом характера патологии выполняются следующие вмешательства:</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;\">при межпозвоночных грыжах: дискэктомия, микродискэктомия, нуклеопластика, радиочастотная денервация фасеточных суставов;</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;\">при сколиозе: коррекция с использованием торакального, дорсального или торакофренолюмботомического доступа;</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;\">при стенозе: фасетэктомия, ламинэктомия, пункционная декомпрессия диска;</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;\">при нестабильности: межтеловой спондилодез, транспедикулярная фиксация, фиксация кейджами и пластинами.</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> </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 послеоперационном периоде назначаются реабилитационные мероприятия, включающие медикаментозную терапию, ЛФК, физиотерапию. Объем и продолжительность восстановительного периода определяются видом операции, тяжестью неврологических расстройств, возрастом больного, другими факторами.</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;\"> </span></p>",
"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;\">Самой действенной профилактикой дорсопатий является соблюдение рационального двигательного режима, регулярное выполнение физических упражнений (под контролем тренера), избегание переохлаждений, лечение сопутствующих заболеваний, своевременное обращение к квалифицированному специалисту — врачу-вертеброневрологу, мануальному терапевту.</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;\">Основными симптомами дорсопатии 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;\">постоянные ноющие боли в спине, напряжение и болезненность на стороне поражения в мышцах шеи, надплечья, спины и конечностей;</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;\">усиление болей при резких движениях, физической нагрузке, поднятии тяжестей, кашле и чихании;</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;\">чувство онемения и ломоты в конечностях, парезы (нарушения чувствительности), слабость в мышцах (вплоть до паралича), со снижением рефлексов и гипотрофиями мышц рук и/или ног;</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;\">спазмы мышц, ограничение подвижности, уменьшение объема движений;</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;\">локальные изменения мягких тканей: сосудистые, дистрофические изменения, нейромио- и нейроостеофиброз.</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 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 локализации дорсопатии возможны следующие симптомы:</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;\">при дорсопатии шейного отдела позвоночника: боли в руках, плечах, головные боли. Возможны также жалобы на шум в голове, головокружение, мелькание «мушек», цветных пятен перед глазами. В сочетании с пульсирующей головной болью это дает основание предполагать так называемый «синдром позвоночной артерии» (одно из осложнений шейной дорсопатии).</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;\">при дорсопатии грудного отдела позвоночника: боль в области грудной клетки, в области сердца и других внутренних органов;</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;\">при дорсопатии пояснично-крестцового отдела позвоночника: боль в пояснице, иррадиирующая в крестец, нижние конечности, иногда в органы малого таза;</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;\">при поражении нервных корешков (грыжи межпозвонковых дисков, остеохондроз, спондилолистез, спондилоартроз): стреляющая боль и нарушение чувствительности, гипотрофия, гипотония, слабость в иннервируемых мышцах, снижение рефлексов.</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> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
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},
"code": "M54",
"name": "Дорсалгия",
"icd_name": "Дорсалгия",
"gender": 0,
"age_min": 10,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "m54_dorsalgiya",
"lead": "болевой приступ в спине, появляющийся на фоне патологии позвоночного столба, воспаления мышечных тканей",
"description": "<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;\">Дорсалгия является основным проявлением проблем с позвоночником, которые могут быть следствием прогрессирующего заболевания позвоночника (остеохондроз, радикулит, грыжа диска и других), смещения позвонков в результате чрезмерной нагрузки, падения, неловкого движения на фоне ослабленного мышечного корсета, а также других факторов.</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;\">Причины возникновения дорсалгии можно разделить на 4 группы:</span></p>\r\n<ol style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: decimal; font-size: 6pt; font-family: Verdana; color: #333333; 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;\">причины вертеброгенного характера — вызваны прогрессирующим заболеванием позвоночника и рефлекторными синдромами поражения позвоночника;</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 6pt; font-family: Verdana; color: #333333; 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;\">причины миофасциального характера — вызваны миофасциальными болями, растяжением или перегрузкой нетренированных мышц и связок, например, — мышечная крепатура.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 6pt; font-family: Verdana; color: #333333; 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;\">причины патологии внутренних органов — вызваны заболеванием или патологическим процессом внутренних органов, например, — почек или тазовых органов, у женщин — яичников, и другие;</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 6pt; font-family: Verdana; color: #333333; 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;\">причины психогенного характера — вызваны психологическим и психическим состоянием человека, например, — стресс.</span></p>\r\n</li>\r\n</ol>\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;\">Основной причиной дорсалгии являются причины вертеброгенного характера. В свою очередь вертеброгенные причины могут быть обусловлены:</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: 6pt; font-family: Verdana; color: #333333; 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;\">остеохондрозом позвоночника или его осложнениями (межпозвонковая грыжа /межпозвоночная грыжа, шейный спондилез и другими);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333333; 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;\">заболеваниями позвоночника не связанными с остеохондрозом позвоночника (болезнь Бехтерева, остеопороз и другими).</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;\">Факторы риска появления дорсалгии:</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: 6pt; font-family: Verdana; color: #333333; 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;\">малоактивный образ жизни;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333333; 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;\">отсутствие регулярных умеренных физических нагрузок (утренняя гимнастика, занятие в спортзале, плавание);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333333; 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;\">систематические избыточные физические нагрузки (тяжелая физическая работа);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333333; 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;\">растяжение мышц спины;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333333; 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;\">экстремальные физические нагрузки у людей со слабым мышечным корсетом (перегрузка нетренированных мышц);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333333; 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 сидячей работе — неудобное рабочее место и/или длительное нахождение в \"неправильной\" позе;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333333; 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;\">избыточный (лишний) вес и ожирение;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333333; 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;\">переохлаждение и нахождение на сквозняке;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333333; 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;\">работа в условиях резких температурных колебаний;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333333; 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;\">работа, связанная с систематической микротравматизацией (например, работа отбойным молотком или длительное вождение автомобиля);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333333; 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;\">падения и травмы;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333333; 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;\">патологии и заболевания внутренних органов;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333333; 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;\">стресс, депрессия и другие психоэмоциональные причины;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6pt; font-family: Verdana; color: #333333; 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;\">вредные привычки (курение, алкоголь и другие).</span></p>\r\n</li>\r\n</ul>",
"pathogenesis": "",
"diagnostics": "<p> </p>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">К методам диагностики дорсалгии относят:</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: #6d6e71; 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;\">Рентгенографию – выполняется в двух проекциях: передней и боковой. Данный метод позволяет выявить компрессионные переломы (могут быть вызваны остеопорозом и пр.), смещения позвонков и прочие деформации позвоночного столба. Также данный метод исследования позволяет специалистам оценить состояние спинномозгового канала пациента.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">Миелографию – рентгеновский снимок при использовании контрастного вещества. Миелография позволяет определить состояние спинного мозга.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">Компьютерную томографию (КТ) – позволяет получить послойные снимки, при помощи которых можно точнее определить место локализации болезни или повреждения, наличие или отсутствие повреждений спинного мозга.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">Магнитно-резонансную томографию (МРТ) – данный метод исследования является самым точным и результативным из всех вышеперечисленных. Он позволяет определить все типы повреждений позвоночного столба, спинномозгового мозга, спинномозговых нервов и кровеносных сосудов.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">Спинномозговую пункцию – забор спинномозговой жидкости осуществляется при подозрении на наличие у пациента доброкачественных или злокачественных опухолей в позвоночнике. Данный метод позволяет узнать о кровоизлияниях в спинной мозг и выявить наличие гнойных или воспалительных процессов.</span></p>\r\n</li>\r\n</ul>",
"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;\">Схема терапии зависит от результатов диагностики и конкретной причины болей в спине. Для быстрого купирования симптома широко применяются анальгетики, противовоспалительные препараты. Они не только купируют неприятный симптом, но и обладают противовоспалительным эффектом. Также могут проводиться паравертебральные блокады анестетиками (новокаином, лидокаином, прокаином). Их сочетают с кортикостероидными препаратами. Как правило, достаточно до 4 блокад для того, чтобы устранить выраженный болевой синдром.</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;\">Из медикаментов также могут применяться сосудистые лекарственные препараты. Это связано с вазомоторным компонентом в происхождении болей, поэтому используют вазоактивные средства. В некоторых случаях достаточно сосудорасширяющих медикаментов на основе никотиновой кислоты, в других – потребуется фармакотерапия нарушений артериального притока и венозного оттока.</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;\">Применяются и немедикаментозные методы терапии: физиотерапия (диадинамические токи, СВЧ, магнитотерапия, УФ-воздействие и пр.) позволяет уменьшить боль, нормализовать кровообращение, в том числе улучшить отток крови из области компрессии, снять спазм мышц. Впоследствии, после купирования острых симптомов, назначают процедуры для улучшения трофики тканей, устраняющие ограничения подвижности, к ним относят светолечение, лазеромагнитотерапию.</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;\">Также может быть показана кинезиотерапия, массаж, ЛФК. Комплексный подход позволяет достичь стойкой ремиссии при заболеваниях опорно-двигательного аппарата, снизить неприятные ощущения, дискомфорт, боль, купировать ограничения подвижности. При отсутствии болей необходимо поддерживать активность, исключая вертикальные и скручивающие нагрузки на позвоночный столб.</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;\">Чтобы избежать возникновения дорсалгии рекомендуется придерживаться следующих профилактических мер:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">укреплять мускулатуру спины при помощи упражнений;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">разминать время от времени спину при длительной сидячей работе;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">контролировать вес поднимаемых тяжестей и равномерно распределять нагрузку на обе верхние конечности;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">ежедневно потреблять необходимое количество витаминов и минералов (рекомендуется перейти на здоровое питание);</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">сменить матрас и подушку на ортопедические;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">своевременно обращаться к специалисту при возникновении заболеваний опорно-двигательного аппарата.</span></li>\r\n</ul>",
"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;\">Основными симптомами, которыми характеризуется дорсалгия, являются 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;\">Чаще всего при дорсалгии боль локализуется в области лопаток</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;\">Болезненные ощущения в области грудной клетки при осуществлении вдохов и выдохов (боль может отдавать в межреберье).</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;\">Боли ноющего характера возникающие под лопатками, усиливающиеся во время двигательной активности и во время осуществления наклонов корпуса.</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 подвижности спины.</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;\">Значительное усиление болезненных ощущений при длительном нахождении в стоячем положении.</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;\">Усиление болезненности при поднятии рук вверх.</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;\">Боли в спине усиливаются во время кашля или чихания.</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;\">Боли при дорсалгии могут иметь ноющий характер и продолжаться длительное время. А могут быть острыми, простреливающими и усиливаться во время любых движений.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><strong style=\"font-weight: normal;\"> </strong></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;\">Так как симптомы дорсалгии слишком схожи со многими другими патологическими состояниями, ее помогут определить дополнительные симптомы:</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;\">ощущение «мурашек на коже» в том отделе позвоночника, в котором локализована причина возникновения дорсалгии;</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;\">онемение одной их верхних или одной из нижних конечностей;</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;\">общая мышечная слабость;</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;\">нарушение осанки и походки;</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;\">головные боли и головокружения;</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;\">чувство онемения спины;</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;\">боли, отдающие в бедро.</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><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;\"> </span></p>",
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