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},
"code": "S83.0",
"name": "Вывих надколенника",
"icd_name": "Вывих надколенника",
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"age_min": 1,
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"slug": "s83.0_vyvih_nadkolennika",
"lead": "смещение коленной чашечки относительно других структур сустава",
"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;\">Как правило, причиной вывиха надколенника становится прямая травма (падение на коленный сустав, боковой удар в область надколенника), сочетающаяся с сокращением четырехглавой мышцы. Боковой вывих надколенника обычно возникает при разогнутой голени. При сгибании в коленном суставе боковой вывих практически невозможен, поскольку наколенник плотно прижат к межмыщелковой поверхности бедренной кости. В редких случаях при согнутой голени возможен вертикальный вывих надколенника.</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;\">Вероятность вывиха надколенника увеличивается при мелкой надколенной впадине, слабо развитом наружном мыщелке бедра, нарушении соотношений между осью четырехглавой мышцы и собственных связок надколенника. Обычно до момента травмы эти анатомические особенности никак не проявляются и остаются незамеченными.</span></p>",
"pathogenesis": "",
"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;\">Диагноз вывиха надколенника выставляется травматологом-ортопедом на основании характерного анамнеза, клинической картины и данных рентгенографии. Наиболее информативны сравнительные рентгенограммы обеих надколенников, проведенные при касательном направлении рентгеновских лучей спереди и сверху вниз или снизу вверх.</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;\">Основанием для диагностирования привычного вывиха являются повторные смещения надколенника, происходящие без выраженного травматического воздействия. Привычные и застарелые вывихи надколенника могут быть показанием для проведения МРТ коленного сустава. При решении вопроса о целесообразности операции проводится диагностическая артроскопия коленного сустава.</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;\">Острый вывих обычно лечится консервативно. Производят вправление вывиха под местной анестезией. Конечность сгибают в тазобедренном суставе (для ослабления натяжения сухожилий четырехглавой мышцы) и разгибают в коленном суставе. Затем аккуратно смещают надколенник до устранения вывиха и накладывают гипсовую повязку.</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;\">После вправления обязательно назначают контрольную рентгенограмму для подтверждения вправления вывиха и выявления костно-хрящевых тел, которые иногда образуются при травме. При остром вывихе надколенника показана иммобилизация сроком 4-6 недель. Массаж и физиолечение проводят под контролем физиотерапевта, не снимая лонгету. Полную нагрузку на ногу разрешают через месяц с момента травмы.</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;\">Оперативное лечение острого вывиха надколенника проводят при выявлении костно-хрящевых тел и высокой вероятности повторных вывихов, обусловленной изменениями в коленном суставе. Застарелые и привычные вывихи надколенника являются показанием к оперативному лечению. После операции показана иммобилизация сроком на 4—6 недель. Полный объем движений в коленном суставе разрешают через 8-10 недель.</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 вывих надколенника не произошел, требуется соблюдать такие меры профилактики:</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: 6.999999999999999pt; font-family: Verdana; color: #304080; 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;\">Ежедневно нужно выполнять несложные физические упражнения, которые помогут укрепить мышцы и связки, удерживающие коленную чашечку.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; 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;\">Лучше избегать резких движений и сильной нагрузки на сочлeнение.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; 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 генетической предрасположенности или деформации сустава лучше отказаться от танцев, катания на лыжах, прыжков.</span></p>\r\n</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;\">Симптомы различны, зависят от вида вывиха. Характерными признаками 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;\">Острая боль в области колена</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 боли при попытке движения в поврежденном суставе</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;\">Выраженная деформация колена: нарастание отека, увеличение размера сустава.</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;\">Если вывих сопровождается разрывом связок, то в суставной полости скапливается кровь – гемартроз.</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;\">Нестабильность коленного сустава – больной не может встать на травмированную ногу.</span></li>\r\n</ul>\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;\">Симптомы привычного вывиха надколенника:</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;\">повышенная подвижность коленной чашечки</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;\">неустойчивость 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;\">быстрая утомляемость пораженной конечности при ходьбе</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>",
"image": null,
"image_alt": null,
"standard_type": 0,
"danger": 20,
"published": 1,
"parent": 7342,
"block_rubric": 208,
"standards": []
}
]
}