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"code": "L88",
"name": "Пиодермия гангренозная",
"icd_name": "Пиодермия гангренозная",
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"age_min": 0,
"age_max": 100,
"cause": [
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],
"periodicity": 3,
"slug": "l88_piodermiya_gangrenoznaya",
"lead": "хроническое нагноение кожи с прогрессирующим некрозом тканей",
"description": "",
"etiology": "<p>Чаще всего на пораженных участках кожи выявляются такие микроорганизмы, как Streptococcus haemolyticus, Staphylococcus aureus, S. albus. Эти кокки выделяют различные экзотоксины и ферменты, которые определяют клиническое отличие различных пиодермий.Пиодермия развивается под влиянием различных экзогенных и эндогенных факторов.</p>\r\n<p>Экзогенные факторы</p>\r\n<ul>\r\n<li>Травматизация кожи.</li>\r\n<li>Загрязнение кожи, несоблюдение гигиенических норм, чрезмерное обезжиривание кожи.</li>\r\n<li>Нарушение секреторной функции кожи.</li>\r\n</ul>\r\n<p>Эндогенные факторы</p>\r\n<ul>\r\n<li>Фокальная инфекция.</li>\r\n<li>Заболевания желудочно-кишечного тракта.</li>\r\n<li>Нарушения обмена веществ.</li>\r\n<li>Заболевания эндокринной системы.</li>\r\n<li>Неврозы, психическая травма.</li>\r\n<li>Хроническая интоксикация.</li>\r\n<li>Иммунный дефицит, ВИЧ-инфекция.</li>\r\n</ul>",
"pathogenesis": "<p><span id=\"docs-internal-guid-aca276b1-7fff-925e-dd63-afdf2c6451d4\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Процесс формирования язвы при гангренозной пиодермии проходит три стадии. На стадии иммунных реакций происходит накопление специфических для определённого вида антигена антител. При этом иммунные лимфоциты и антитела класса Е из крови переходят в ткани кожи, сенсибилизируя её. На второй (патохимической) стадии заболевания повторное попадание чужеродного антигена вызывает активацию протеолитических ферментов клеток и тканей с нарушением их функций. Эпидермальные клетки начинают вырабатывать биологически активные вещества, провоцирующие воспаление. На третьей (патофизиологической) стадии возникает специфический ответ кожи на внедрение патологического антигена в виде дегрануляции клеток, разрушения сосудов, нарушения трофики и локальной деструкции ткани. Глубина деструкции зависит от количества патогенного антигена и степени устойчивости иммунной системы.</span></span></p>",
"diagnostics": "<p>Клинический диагноз ставится дерматологом на основании анамнеза, специфической симптоматики и консультаций узких специалистов, поскольку гангренозная пиодермия является междисциплинарным заболеванием. Гистология очага поражения не показательна, но в сложных случаях полезна. Выявляется тромбоз сосудов, гранулематозные инфильтраты, островки деструкции в эпидермисе и дерме. Дополнительно проводят электрофорез сывороточного белка, исключают микотическую природу язвы, берут кровь на RW.</p>",
"treatment": "<p><span id=\"docs-internal-guid-86eb6e11-7fff-fefe-229c-1391e5ce073a\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Терапию гангренозной пиодермии начинают с коррекции соматической патологии у профильных специалистов, поскольку кожный патологический процесс без этого плохо поддаётся терапии. Целью дерматологического лечения является снятие воспалительных проявлений, болезненных ощущений, восстановление кожных покровов. Для этого проводят курсы гормонотерапии и антибиотикотерапии. В тяжёлых случаях подключают цитостатики, иммуносупрессоры, калия иодид, внутривенно вводят иммуноглобулин. Показан плазмаферез. Наружно при гангренозной пиодермии очищают поверхность дефекта кожи с помощью вибрационно-турбулентных ванн, антисептических растворов. Применяют влажно-высыхающие повязки с растворами серебра, гормональные препараты. С учётом патергии стараются избегать хирургических манипуляций.</span></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;\">Основные методы профилактики:</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;\">гигиенический уход за кожей;</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;\">своевременная обработка порезов и ожогов;</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;\">лечение хронических инфекций;</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;\">регулярные обследования у дерматолога при хронических кожных заболеваниях;</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;\">контроль уровня сахара в крови при диабете.</span></li>\r\n</ul>\r\n<p> </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>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Гангренозная пиодермия встречается обычно у взрослых, дети болеют редко. Очаги поражения часто локализуются на нижних конечностях, но могут развиться и на других участках.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Гангренозная пиодермия начинается с образования фурункулоподобных инфильтратов или пустул. Последние быстро некротизируются и эксцентрически увеличиваются в размерах. Язвы имеют отечный воспалительный ободок шириной 1-1,5 см, подрытые края, гнойное, кровянисто-гнойное неровное дно и участки некроза тканей. В отделяемом язвы обнаруживают различную кокковую и бактериальную флору. В пределах валикообразной инфильтрации имеются множественные мелкие пустулы и очаги некроза. Очаги серпигинируют во всех или в одном каком-либо направлении, одновременно рубцуясь в другом. Гангренозная пиодермия субъективно проявляется сильной болью. У половины больных наблюдается одиночный очаг. Общее состояние остается удовлетворительным, но у некоторых больных отмечаются преходящая лихорадка и недомогание. </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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Системные признаки: лихорадка, общее недомогание и артралгия. Язвы сливаются, формируя большие язвы, часто с обширным рубцеванием, далее развивается патергия. Характерно рецидивирующее течение заболевания.</span></p>\r\n<p><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"image": "http://api.symptomd.ru/storage/d5f454e0662dc71bf3ba37ff48996828_R7Aowj2.jpg",
"image_alt": "Гангренозная пиодермия.",
"standard_type": 1,
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"parent": null,
"block_rubric": 127,
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},
{
"id": 6777,
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{
"name": "увеличение лимфоузлов"
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{
"name": "лимфоузел воспаление"
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{
"name": "лимфоузлы набухли"
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{
"name": "увеличились лимфоузлы"
}
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"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;\">Главным этиологическим фактором возникновения язвы является постоянное воздействие травмирующего раздражителя на слизистую оболочку полости рта. На первом этапе поверхностный слой слизистой подвергается инфильтрации, затем происходит инфицирование, и начинается воспаление. В эпителии пораженной области формируется язва, дно которой покрыто грануляциями и гнойным налетом. Самыми распространенными раздражителями являются зубы с запущенным кариозным процессом и острыми краями, неграмотно установленные пломбы, выходящие за границы коронок, любые ортопедические и ортодонтические конструкции.</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;\">Даже самые качественные съемные протезы оказывают давление на слизистую полости рта и препятствуют естественному самоочищению, что в результате приводит к ухудшению тканевого кровообращения и нарушению баланса микрофлоры. Любые искусственные коронки, края которых погружены в десневой желобок, раздражают слизистую оболочку десны. Нередко декубитальная язва развивается у пациентов с нарушениями прикуса в результате давления бугров коренных зубов. Дети тоже подвержены развитию данной патологии из-за склонности прикусывать щеки и язык в момент прорезывания молочных зубов. Дополнительными факторами, способствующими формированию декубитальной язвы, являются курение, неправильное питание, авитаминоз, иммуносупрессивные состояния, сосудистые заболевания и сахарный диабет.</span></p>",
"pathogenesis": "<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;\">Декубитальная или травматическая язва полости рта появляется вследствие постоянной травматизации слизистой оболочки. Глубина и выраженность очага поражения зависит от силы и времени действия раздражающего фактора. В стоматологии декубитальные язвы встречаются у пациентов всех возрастов, в т. ч. и у детей при прорезывании молочных зубов, но наиболее часто они беспокоят пожилых людей со съемными протезами и другими ортопедическими и ортодонтическими конструкциями. Локализация язвенного дефекта может быть любой, однако у взрослых пациентов патологический процесс в большинстве случаев затрагивает язык и щеки из-за постоянного контакта с острыми краями кариозных зубов и выступами протезов. При отсутствии лечения велика вероятность присоединения вторичной инфекции, а при запущенном течении – малигнизации язвенного дефекта.</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;\">Как правило, для диагностики заболевания достаточно сбора анамнеза и поверхностного осмотра. Декубитальную язву легко спутать с некоторыми другими заболеваниями, поэтому необходимо проводить дифференциальную диагностику – в частности, отличить язву от твёрдого шанкра, туберкулёзной и трофической язв.</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;\">Одним из главных способов дифференцировать декубитальную язву от других заболеваний является устранение провоцирующего травму фактора. Если после того, как травматизация прекратилась, новообразование не исчезло, требуется дополнительная диагностика для уточнения диагноза. Цитологический анализ – то есть анализ тканей язвы – может помочь обеспечить более точную диагностику. Для его проведения может понадобиться биопсия.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основная цель лечения – это устранение или ослабление действия травмирующего фактора. В обязательном порядке проводится санация полости рта, пломбирование кариозных зубов и замена старых некачественных пломб на новые. Необходимо свести к минимуму раздражающее воздействие всех ортопедических и ортодонтических конструкций. Пациентам с выраженным болевым синдромом рекомендуется проведение теплых полосканий, аппликаций или орошений местными анестетиками (лидокаин, новокаин, пиромекаин).</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;\">Чтобы устранить некротический или фибринозный налет, используются аппликации протеолитических ферментов (трипсин, химотрипсин), после чего налет легко удаляют шпателем, а язвенный дефект обрабатывают антисептическими средствами (перекись водорода, диметилсульфоксид). Для ускорения заживления используются мази с репарационным действием (метилурациловая и пр.). Как только начинается процесс эпителизации язвы, рекомендуется наносить кератопластические средства (облепиховое масло, поливинокс).</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;\">Для профилактики необходимо регулярно проходить осмотры у врача-стоматолога, проводить лечение кариозных зубов и выбирать высококвалифицированных специалистов для ортодонтического и ортопедического лечения.</span></p>",
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"description": "Гранулематозные поражения кожи - большая группа заболевания, при которых в кожи образуются гранулемы. Гранулема - инфильтрат в коже, состоящий из макрофагов и их производных. Внешне гранулема выглядит как дермальный (кожный) узелок.",
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"pathogenesis": "<p>В процессе формирования гранулемы ведущая роль принадлежит клеточному иммунитету. Присутствие в коже плохорастворимого агента активируют имунные клетки, которые фагоцитируют и разрушают внедриагент или, отграничивают его.</p><p> </p>",
"diagnostics": "<p>Диагноз можно поставить при визуальном осмотре, применяя некоторые инструментальные методы (диаскопия). Для уточнения диагноза выяснения причины, используют гистологическое исследование.</p>",
"treatment": "<p>При лечении гранулематозных поражений кожи применяют несколько групп препаратов:</p><p> - антибиотики и противогрибковые средства при гранулемах, вызванных инфекционными и грибковыми агентами;</p><p>- противомикробные средства из группы сульфонов (дапсон);</p><p>- глюкокортикостероиды. Чаще используют в виде мазей или внутрикожных иньекций;</p>",
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},
"code": "M00",
"name": "Пиогенный артрит",
"icd_name": "Пиогенный артрит",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "m00_piogennyy_artrit",
"lead": "воспалительное заболевание суставов, обусловленное попаданием инфекции в полость сустава через повреждения на коже или возникающее вследствие наличия острых или хронических заболеваний, вызванных бактериями",
"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;\">Пиогенный артрит, называемый также септическим артритом или инфекционным артритом, является серьезной болезнью суставов, характеризующейся болью, температурой, ознобом, покраснением и отеком одного или нескольких суставов, а также потерей подвижности пораженных суставов.</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;\">Развитию инфекционного артрита способствуют следующие факторы:</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;\">различные хронические артриты</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;\">системные инфекционные 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;\">системные заболевания соединительной ткани</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;\">иммунодефицитные состояния (как правило, у пациентов, страдающих иммунодефицитом, развивается полиартрит)</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;\">онкологические 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;\">внутрисуставные инъекции или хирургические вмешательства на суставах, в ходе которых в ткани сустава может быть занесена инфекция</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;\">сахарный диабет</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;\">травмы</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">наличие протезов 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;\">алкоголизм и наркомания (наркозависимые пациенты часто страдают поражением суставов осевого скелета)</span></li>\r\n<li><span id=\"docs-internal-guid-552472a8-7fff-8131-83f0-95ef23c608a6\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">прием ряда препаратов, в том числе гормональных</span></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\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </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;\">Как правило, возбудитель артрита попадает в сустав с током крови или лимфы. В зависимости от того, какой именно возбудитель вызвал заболевание, различают бактериальный, вирусный, грибковый и паразитарный артриты.</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;\">Если возбудитель попадает в сустав извне, то такой артрит называется первичным. Если очаг воспаления находится в самом организме, то есть инфекция попадает из других органов и тканей, то артрит называется вторичным.</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 инфекционный артрит может развиться в результате травмы сустава и попадания возбудителей воспаления в рану. </span></p>",
"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;\">При подозрении на развитие инфекционного артрита пациента направляют на рентген или УЗИ суставов. Также необходимо сделать анализ крови, иммунограмму, исследовать внутрисуставную жидкость, для анализа берутся мазки из половых путей. При подозрении на туберкулезную природу артрита проводится исследование для выявления очагов туберкулеза.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основные принципы лечения инфекционных артритов:</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;\">подавление инфекции, вызвавшей поражение 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;\">дезинтоксикационная терапия – выведение из организма токсических продуктов воспаления;</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;\">предупреждение рецидивов заболевания и дальнейшего разрушения суставов.</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\"><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;\">Разные клинические формы инфекционного артрита требуют разного подхода к лечению. Так, острые гнойные и другие, протекающие тяжело артриты, лечатся только стационарно. При хроническом течении возможно амбулаторное лечение или его сочетание со стационарным во время обострения. На этом этапе основными методами лечения инфекционного артрита являются хирургическое и медикаментозное в сочетании с иммобилизацией (созданием неподвижности) пораженных суставов.</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;\">В дальнейшем, на стадии восстановления присоединяются немедикаментозные методики: лечебная гимнастика, массаж, физиотерапевтические процедуры, курсы рефлексотерапии.</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 острых гнойных артритов</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;\">При нагноительном процессе в суставах проводят следующие хирургические манипуляции и операции:</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;\">артроцентез - пункция сустава (прокол иглой со шприцем) с последующим удалением гнойного экссудата, промыванием (лаважем) суставной полости дезинфицирующим раствором и введением антибиотиков;</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;\">лечебная артроскопия – та же самая процедура, но проводится при помощи эндоскопической аппаратуры (артроскопа); во время артроскопии можно удалить не только гной, но и кусочки некротизированной ткани, секвестры костей;</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;\">артротомия с проточно-аспирационным дренированием – проводится при большом скоплении гноя и деструкции сустава; полость сустава раскрывается традиционным хирургическим способом, после чего проводится удаление гноя,регулярное промывание суставной полости дезинфицирующими растворами с введение в нее антибиотиков.</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> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
"prevention": "<p><span id=\"docs-internal-guid-aa0d875c-7fff-a70d-1da2-4fa91cfb01c1\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Инфекционный артрит можно предупредить, занимаясь закаливанием, спортом без тяжелых физических нагрузок, правильно питаясь и вовремя пролечивая все инфекции.</span></span></p>",
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},
"code": "M02",
"name": "Реактивные артропатии",
"icd_name": "Реактивные артропатии",
"gender": 0,
"age_min": 0,
"age_max": 94,
"cause": [
3,
2,
5,
7,
8,
9
],
"periodicity": 1,
"slug": "m02_reaktivnye_artropatii",
"lead": "Нарушение здоровья, относящееся к группе инфекционные артропатии",
"description": "Реактивная артропатия — это воспалительное поражение суставов, которое возникает после перенесенных инфекций мочеполовой системы, кишечника или органов дыхания. ",
"etiology": "<p>Peaктивный apтpит paзвивaeтcя вcлeдcтвиe cлeдyющих пpичин: </p>\r\n<ul>\r\n<li>paзличных виpycных инфeкций (caльмoнeллa, шигeллa, кaмпилoбaктep); </li>\r\n<li>инфeкциoнных зaбoлeвaний (дизeнтepия); </li>\r\n<li>иммyнных aнoмaлий; </li>\r\n<li>гeнeтичecкoй пpeдpacпoлoжeннocти к дaннoмy нeдyгy (зaбoлeвaниe чaщe paзвивaeтcя y нocитeлeй aнтигeнa HLA- B 27; </li>\r\n<li>инфициpoвaниe микpoopгaнизмaми, пpoникaющими в мoчeпoлoвyю cиcтeмy (хлaмидии, ypeaплaзмa). </li>\r\n</ul>",
"pathogenesis": "<p>Наиболее частой причиной реактивного артрита является урогенитльная или кишечная инфекция. Однако манифестация реактивного артрита напрямую не связана с попаданием инфекции в сустав, а вторичное воспаление суставов развивается не у всех пациентов, перенесших инфекционное заболевание. </p>\r\n<p>Подобная избирательность, с точки зрения иммуногенетической теории, объясняется предрасположенностью к реактивному артриту лиц с гиперреакцией иммунной системы на микробных агентов, циркулирующих в крови и персистирующих в суставной жидкости и тканях. Вследствие микробной мимикрии – сходства антигенов инфекционного возбудителя и суставных тканей – иммунный гиперответ обращен не только на микроорганизмы, но и на аутоткани сустава. В результате сложных иммунохимических процессов в суставах развивается асептическое (негнойное) реактивное воспаление. </p>",
"diagnostics": "<p>Диагноз реактивный артрит устанавливается на основании истории болезни (наличие первичного инфекционного заболевания), клинических проявлений, и данных лабораторного и инструментального обследования. </p>\r\n<p>В общем анализе крови отмечается лейкоцитоз, ускорение СОЭ и анемия. </p>\r\n<p>В общем анализе мочи – протеинурия (потеря белка), микрогематурия (потеря эритроцитов) и лейкоцитурия (выделение лейкоцитов). </p>\r\n<p>В крови отсутствует повышение ревматоидного фактора, зато высокий титр антител к возбудителю инфекции (чаще всего – к хламидиям) и главное – выявляется HLA-B27 антиген. </p>\r\n<p>Реактивный артрит имеет характерную картину синовиальной внутрисуставной жидкости (низкая вязкость, плохое образование муцинового сгустка, лейкоцитоз). Важное значение имеет рентгенологическое исследование пораженных суставов. Для реактивного артрита не свойственно изменение суставных поверхностей. </p>",
"treatment": "<p>Основным принципом терапии реактивного артрита является устранение первичного инфекционного очага в урогенитальном или кишечном тракте. Назначается этиологически обоснованная противомикробная терапия в оптимальных дозировках сроком не менее 4-х недель. При реактивном артрите, обусловленном хламидийной инфекцией, используются препараты групп макролидов, тетрациклинов, фторхинолонов. Одномоментному лечению подлежат половые партнеры даже при отрицательных анализах на хламидиоз. В случае отсутствия динамики после проведенного антибактериального курса повторно назначают препараты другой группы. </p>\r\n<p>Для ликвидации воспалительной реакции в суставах проводится лечение нестероидные противовоспалительные средства (НПВС); при тяжелом течении артрита - глюкокортикостероидами, как системно, так и с помощью внутрисуставных и периартикулярных инъекций. Затяжное течение реактивного артрита может потребовать назначения противовоспалительной терапии базисными цитостатическими препаратами – сульфасалазином, метотрексатом. </p>\r\n<p>С помощью препаратов-ингибиторов фактора некроза опухоли (ФНО) поддаются лечению даже резистентные к терапии формы болезни, купируются признаки артрита, спондилита, острого увеита. </p>\r\n<p>Введение стволовых клеток при реактивном артрите помогает восстановить структуру поврежденного хряща, нормализовать метаболизм, ликвидировать воспаление в суставе. </p>\r\n<p>При образовании воспалительного выпота производят его эвакуацию из полости сустава. Локально используются противовоспалительные кремы, мази, гели, аппликации димексида. </p>\r\n<p>Из методов физиотерапиипри реактивном артрите предпочтение отдается фонофорезу гидрокортизона, синусоидально-модулирующим токам (СМТ), криотерапии, ЛФК. </p>\r\n<p>После купирования острой степени воспаления назначаются процедуры, направленные на восстановление функций суставов - лечебные ванны, грязелечение. </p>",
"prevention": "<p>Профилактика реактивного артрита сводится к профилактике вызывающих его инфекций: соблюдение гигиенического режима в отношении кишечных инфекций, кипячение воды, мытье рук, соблюдение правил хранения и приготовления пищи. Людям, имеющим положительный антиген HLA-B27, рекомендуется профилактический прием антибиотиков во время путешествий. Для профилактики хламидиоза применяются средства защиты при случайных половых контактах. </p>",
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},
"code": "M40",
"name": "Кифоз и лордоз",
"icd_name": "Кифоз и лордоз",
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3
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"lead": "Кифоз - прогиб позвоночника назад, лордоз - прогиб позвоночника вперед. Как правило если в одном отделе позвоночника развивается кифоз, то в другом отделе почти неминуемо развивается компенсационный лордоз, и наоборот",
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"etiology": "<p><a href=\"/symptom/kifoz_i_lordoz/\" title=\"Перейти на страницу симптома Кифоз и лордоз\">Кифоз</a> – <a href=\"/symptom/anormalnoe_polozhenie_tela/\" title=\"Перейти на страницу симптома Анормальное положение тела\">искривление</a> позвоночника, обращенное выпуклостью кзади. У взрослых в норме бывает физиологический грудной и крестцовый <a href=\"/symptom/kifoz_i_lordoz/\" title=\"Перейти на страницу симптома Кифоз и лордоз\">кифоз</a>. Патологический <a href=\"/symptom/kifoz_i_lordoz/\" title=\"Перейти на страницу симптома Кифоз и лордоз\">кифоз</a> может быть углообразным вследствие туберкулеза одного или нескольких позвонков или травмы позвоночника либо дугообразным при рахите, вялом параличе, когда в процесс вовлекается много позвонков. При искривлении всего позвоночника говорят о сутулости, а если <a href=\"/symptom/anormalnoe_polozhenie_tela/\" title=\"Перейти на страницу симптома Анормальное положение тела\">искривление</a> наблюдается в верхнем отделе позвоночника – округлой спине. <a href=\"/symptom/kifoz_i_lordoz/\" title=\"Перейти на страницу симптома Кифоз и лордоз\">Кифоз</a> становится более фиксированным, не поддающимся устранению при длительно существующей порочной осанке. Возможно развитие стойкого кифоза при нарушении процесса окостенения позвонков.</p>",
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"diagnostics": "<p>Ранняя и правильная диагностика помогает вовремя принять адекватные меры и быстро избавиться от заболевания. Тяжелые формы заболевания чрезвычайно трудно поддаются лечению, потому что они сопровождаются деформацией ребер, грудины, ключиц, таза и плечевого пояса.</p>",
"treatment": "<p>В первую очередь необходимо выполнять упражнения, укрепляющие мышцы спины. С лечебной гимнастикой сочетают применение корсетов, массаж, проводят физиотерапию. В случаях, когда причиной кифоза стали туберкулез, опухоль, остеомиелит или другие заболевания, возникает необходимость в оперативном вмешательстве. </p>\r\n<p><a href=\"/symptom/kifoz_i_lordoz/\" title=\"Перейти на страницу симптома Кифоз и лордоз\">Лордоз</a> – изгиб позвоночника, направленный выпуклостью кпереди. Умеренно выраженный <a href=\"/symptom/kifoz_i_lordoz/\" title=\"Перейти на страницу симптома Кифоз и лордоз\">лордоз</a> шейного и поясничного отделов позвоночника является физиологическим. Они формируются на первом году жизни ребенка, создавая основу для удержания головы и всего тела в вертикальном положении. При патологических состояниях возможно углубление лордоза – гиперлордоз, он может сочетаться с другими искривлениями. Гиперлордоз в поясничном отделе позвоночника встречается при спондилолистезе, рахите, во время беременности, при контрактурах тазобедренных суставов. Также гиперлордоз может вызвать деформация шейных позвонков или стягивающие рубцы в области шеи после ожогов. При данном заболевании нарушается осанка, развиваются дистрофические процессы в межпозвоночных дисках, на этом фоне могут возникать боли.</p>",
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"clinical_picture": "<p>В результате нарушений осанки слабеют мышцы спины, это способствует зафиксированию неправильной позы. При угловом кифозе образуется горб. Для рахитического кифоза характерны уплощение и западение грудной клетки, отвисание живота, углубление поясничного лордоза, опущение плеч. При стойком кифозе дыхательные экскурсии грудной клетки ограничиваются, ослабевают мышцы спины, гибкость тела снижается, больной быстро утомляется, ощущаются боли в спине, значительно снижается трудоспособность человека.</p>",
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"code": "M42",
"name": "Остеохондроз позвоночника",
"icd_name": "Остеохондроз позвоночника",
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"age_min": 5,
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"periodicity": 4,
"slug": "m42_osteohondroz_pozvonochnika",
"lead": "Нарушение здоровья, относящееся к группе деформирующие дорсопатии",
"description": "Остеохондроз — это хроническое заболевание, характеризующееся развитием дегенеративно-дистрофических изменений в позвоночнике с поражением межпозвонковых дисков, тел самих позвонков, близлежащих поверхностей суставов и связок. Остеохондроз позвоночника является одной из главных причин болей в спине.",
"etiology": "<p>К причинам, вызывающим развитие остеохондроза позвоночника относят:</p>\r\n<ul>\r\n<li>наследственная (генетическая) предрасположенность;</li>\r\n<li>нарушение обмена веществ в организме, инфекции, интоксикации;</li>\r\n<li>ожирение;</li>\r\n<li>неправильное питание (недостаток микроэлементов и жидкости);</li>\r\n<li>возрастные изменения;</li>\r\n<li>травмы позвоночника (ушибы, переломы);</li>\r\n<li>нарушение осанки, искривление позвоночника, гипермобильность (нестабильность) сегментов позвоночного столба, плоскостопие;</li>\r\n<li>неблагоприятные экологические условия;</li>\r\n<li>малоподвижный образ жизни;</li>\r\n<li>работа, связанная с подъемом тяжестей, частыми изменениями положения туловища (поворотами, сгибанием и разгибанием, рывковыми движениями);</li>\r\n<li>вибрация, например, при вождении транспортных средств;</li>\r\n<li>длительное воздействие неудобных поз в положении стоя, сидя, лежа, при подъеме и переносе тяжестей, при выполнении другой работы, при которой увеличивается давление в дисках и нагрузка на позвоночник в целом;</li>\r\n<li>чрезмерные физические нагрузки, неравномерно развитая костно-мышечная система;</li>\r\n<li>перегрузки позвоночника, связанные с заболеваниями стопы, а также в результате ношения неудобной обуви, высоких каблуков и беременности у женщин;</li>\r\n<li>резкое прекращение регулярных тренировок профессиональными спортсменами;</li>\r\n<li>психоэмоциональные факторы (нервное перенапряжение, стрессовые ситуации);</li>\r\n<li>курение.</li>\r\n</ul>\r\n<p> </p>",
"pathogenesis": "<p>Составными частями межпозвонкового диска являются расположенное в центре студенистое (пульпозное) ядро и прочное волокнистое (фиброзное) кольцо вокруг него. Вследствие плохого питания дисков происходит разрушение структуры студенистого ядра. Оно подвергается обезвоживанию, становится плоским и значительно более хрупким, в результате чего может разделиться на отдельные фрагменты даже при небольших нагрузках. Это приводит к еще большей потере упругости и прочности волокнистых дисковых колец. Перечисленные факторы способствуют формированию благоприятной почвы для появления остеохондроза. Уменьшается расстояние между соседними позвонками, и они смещаются по отношению друг к другу, при этом происходит смещение и в фасеточных (дугоотростчатых) суставах, соединяющих позвонки.</p>\r\n<p>Разрушение соединительной ткани фиброзного кольца диска, связок и капсул фасеточных суставов вызывает реакцию иммунной системы и развитие асептического воспаления с отечностью фасеточных суставов и окружающих их тканей. Из-за смещения тел позвонков происходит растяжение капсул фасеточных суставов, а измененный межпозвонковый диск уже не так прочно фиксирует тела соседних позвонков. Формируется нестабильность позвоночного сегмента. Из-за нестабильности возможно ущемление корешка спинномозгового нерва с развитием корешкового синдрома.</p>\r\n<p>При остеохондрозе происходит разрастание костной ткани с образованием остеофитов — костных выростов на телах и отростках позвонков. Остеофиты также могут вызвать сдавление спинного мозга (компрессионную миелопатию) или стать причиной развития корешкового синдрома.</p>",
"diagnostics": "<p>Диагностика заболевания складывается из клинической картины, неврологического, инструментального и лабораторного обследования пациента.</p>\r\n<p>Неврологическое обследование проводиться врачом-невропатологом по общепринятой схеме, и позволяет выяснить, какие нервные структуры затронуты патологическим процессом, протекающим в позвоночнике.</p>\r\n<p>Основным методом инструментальной диагностики остеохондроза позвоночника является рентгенография. Она позволяет определить следующие объективные симптомы заболевания: изменения в анатомическом строении пораженного сегмента; сдвиг смежных тел позвонков относительно друг друга; уплощение межпозвоночного диска; деформацию замыкающих пластин тел смежных позвонков; неодинаковую высоту межпозвоночного диска, которая видна в прямой проекции на снимке, обусловленная ассиметричным напряжением мышц.</p>\r\n<p>При неясной симптоматике и наличии неврологических нарушений пациентам проводят компьютерную или магниторезонансную томографию. Эти методы диагностики позволяют получить послойное изображение патологического участка позвоночника, окружающих его мышц и сосудов, а также нервной ткани.</p>\r\n<p>Электромиография позволяет дифференцировать неврологическую симптоматику, вызванную сдавлением нервных корешков, патологически измененным позвоночником от периферической невропатии.</p>\r\n<p>Для дифференциальной диагностики остеохондроза и заболеваний внутренних органов могут использоваться и другие методы диагностики (ЭКГ, УЗИ органов брюшной полости и малого таза, ангиография, фиброгастродуоденоскопия и др).</p>\r\n<p> </p>",
"treatment": "<p>Медикаментозная терапия включает:</p>\r\n<ul>\r\n<li>Анальгетики и нестероидные противовоспалительные препараты, направленные на устранение болевых ощущений и воспалительного процесса;</li>\r\n<li>Миорелаксанты – для снятия спазма мышц;</li>\r\n<li>Хондропротекторы – направлены на восстановление разрушенной ткани, утратившей свои первоначальные свойства;</li>\r\n<li>Сосудорасширяющие средства – нормализация кровотока, устранение дефицита питания;</li>\r\n<li>Медикаментозные блокады с глюкокортикоидами при выраженном корешковом синдроме;</li>\r\n</ul>\r\n<p>Витамины группы В – для деятельности окислительных энергетических механизмов и поддержания нормальной структуры и функции нервов.</p>\r\n<p>Тракция (или вытяжение) – суть метода в том, что с помощью специального оборудования на позвоночник оказывается определенная нагрузка (давление), благодаря чему устраняется или значительно сокращается боль и увеличивается межпозвонковое пространство.</p>\r\n<p>Массаж (мануальная терапия). И в первом, и во втором случае улучшается обмен веществ, стимулируются регенерационные свойства клеток тканей, купируется боль.</p>\r\n<p>Физиопроцедуры. Призваны ускорить процесс выздоровления путём воздействия на травмированный участок ультрафиолетом, током, магнитным полем или ультразвуком в сочетании с введением определённых доз лекарственных препаратов под кожу.</p>\r\n<p>ЛФК. Лечебная гимнастика, при условии её регулярности, позволяет достичь трёх целей, а именно: укрепить мышцы, устранить декомпрессию (снизить болевой симптом), улучшить общее состояние больного.</p>\r\n<p> </p>",
"prevention": "<p> Мероприятия по профилактике остеохондроза позвоночника включают:</p>\r\n<ul>\r\n<li>ограничение физических нагрузок; </li>\r\n<li>комплекс упражнений на укрепление мышц живота и спины для формирования мышечного корсета;</li>\r\n<li>регулярное посещение ортопеда с раннего школьного возраста и по необходимости проводение коррекции искривлений позвоночника и нарушений осанки;</li>\r\n<li>употребление продуктов, обеспечивающих организм кальцием и магнием (рыба и морепродукты, шпинат, бобы, орехи, семечки, горох, хлеб грубого помола, молочные продукты, сыры) и витаминами;</li>\r\n<li>профилактика накопления лишнего веса;</li>\r\n<li>избегание ношения сумки на одном плече.</li>\r\n</ul>",
"clinical_picture": "<p>Основные симптомы остеохондроза позвоночника:</p>\r\n<ul>\r\n<li>постоянные ноющие боли в спине, чувство онемения и ломоты в конечностях;</li>\r\n<li>усиление болей при резких движениях, физической нагрузке, поднятии тяжестей, кашле и чихании;</li>\r\n<li>уменьшение объема движений, спазмы мышц;</li>\r\n<li>при остеохондрозе шейного отдела позвоночника: боли в руках, плечах, головные боли; возможно развитие так называемого синдрома позвоночной артерии, который складывается из следующих жалоб: шум в голове, головокружение, мелькание «мушек», цветных пятен перед глазами в сочетании с жгучей пульсирующей головной болью;</li>\r\n<li>при остеохондрозе грудного отдела позвоночника: боль в грудной клетке, в области сердца и других внутренних органах;</li>\r\n<li>при остеохондрозе пояснично-крестцового отдела позвоночника: боль в пояснице, иррадиирующая в крестец, нижние конечности, иногда в органы малого таза;</li>\r\n<li>поражение нервных корешков: стреляющая боль и нарушение чувствительности, гипотрофия, гипотония, слабость в иннервируемых мышцах, снижение рефлексов.</li>\r\n</ul>\r\n<p> </p>",
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