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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;\">В зависимости от патогенетического фактора различают переломы:</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;\">Травматические. Острые повреждения вызваны падением на стопу тяжелых предметов, скручиванием ее переднего отдела (чаще возникает перелом основания пятой плюсневой кости) и пр. На открытые повреждения приходится 10%.</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;\">Патологические. Ряд факторов — остеопороз, остеомиелит, опухолевый процесс, прием лекарств, генетические аномалии, несбалансированное питание с дефицитом минералов и витаминов — способствуют ослаблению костной ткани. Для получения перелома достаточно незначительного усилия.</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;\">Стрессовые. С воздействием постоянного травматического фактора низкой/умеренной интенсивности на стопы сталкиваются военные, вынужденные много маршировать, артисты балета, спортсмены. Вторая и третья плюсневые кости стопы фиксированы; первая, четвертая и пятая — относительно подвижны. Поэтому перелом 4 плюсневой кости стопы встречается часто. Во время ходьбы и танцев основная нагрузка приходится на вторую и третью плюсневые кости, поэтому риск усталостных переломов указанных структур выше.</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;\">Нейропатические. Перелом плюсневой кости (чаще - пятой) обнаруживают у пациентов с осложненным сахарным диабетом. При полинейропатии изменяется чувствительность в ногах, и человек не в состоянии контролировать силу воздействия по причине утраты чувствительности.</span></li>\r\n</ul>\r\n<p> </p>",
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"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;\">В зависимости от клинической картины пациенту может быть выполнены:</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;\">Рентгенография — базовое исследование, которое выполняют при травме стопы. Информации часто недостаточно. Стрессовый перелом на ранней стадии не визуализируется на обычных рентгенограммах или присутствует незначительная периостальная реакция, которую легко пропустить. Исследование показывает перелом костей плюсны, но не подходит для диагностики повреждений мягких тканей и связок.</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;\">Компьютерное сканирование предоставляет больше информации о патологии. Показания включают подозрение на стрессовый перелом при неоднозначных данных рентгенографии. КТ демонстрирует отрывные, оскольчатые повреждения и все патологии костной 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;\">Магнитно-резонансная томография — наиболее информативный способ исследования при сложной травме ступни с вовлечением мягких тканей и разрывом/растяжением связок. Снимок МРТ показывает отек костного мозга раньше, чем КТ. Магнитно-резонансная томография — лучший способ визуализации стрессовых переломов стопы, подходит для дифференциации последних и синовита, дегенеративных изменений. Оптимальный вариант для получения полной картины составляющих стопы — предплюсны, плюсны, пальцевых фаланг, твердых и мягкотканных структур — сочетание магнитно-резонансной томографии и компьютерного сканирования.</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;\">Ультразвуковое исследование в травматологии нашло применение благодаря доступности, простоте использования, но в качестве единственного способа диагностики УЗИ неприменимо.</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;\">Консервативное 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;\">Консервативное лечение имеет смысл при следующем характере повреждений: </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;\">переломы без смещения лечатся накладыванием шины, тугой повязки. В течение нескольких недель на ногу не опираются; </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;\">переломы с небольшим смещением вправляются, затем накладывают гипс на 4 недели. Стопа находится в функциональном покое, при ходьбе или стоянии опираются на костыли. </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;\">Промедление с оказанием медицинской помощи при травме плюсны обернётся пониженной подвижностью стопы, болью при ходьбе, развитием артроза. </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 </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;\">Операцию делают при сильном смещении костных обломков. Основные способы хирургического 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;\">малотравматичным методом лечения перелома плюсневых костей со смещением является чрезкожная фиксация спицами. Под контролем рентгена сквозь отломки костей продевают спицы из нержавейки. После заживления костной ткани спицы вынимают; </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 многооскольчатых переломах производят разрез тканей, сопоставляют обломки, фиксируют их металлическими пластинками и винтами. </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;\">Иногда при операции повреждаются нервы и сухожилия стопы, неверно собирают обломки. Это чревато хромотой, изменением формы стопы, болезненностью, отёками. </span></p>",
"prevention": "<p><span id=\"docs-internal-guid-68f011e4-7fff-2ee3-1ef8-c50757c0a316\"><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;\">Профилактика подразумевает дозирование нагрузки на стопу, выбор подходящей обуви (с фиксацией стопы) при занятиях спортом. Уменьшить вероятность нейропатических повреждений ноги можно, если взять за правило вставать максимально аккуратно, с поддержкой на опору. Пожилые пациенты должны быть обследованы в обязательном порядке на остеопороз. При выявлении нарушений минерального обмена обязательно патогенетическое лечение.</span></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;\">Признаки перелома плюсневой кости в большинстве случаев настолько явные, что диагностика не представляет сложностей. Однако при некоторых типах травмы больные не ощущают характерные симптомы травмы, поэтому может быть поставлен неправильный диагноз. Типичными проявлениями перелома 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, возникшая сразу после получения повреждения. Пациенты не могут встать на ногу, а при попытке опереться возникает резкая болезненность в стопе;</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;\">стремительная отечность, которая нарастает в первые часы после 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;\">слышимый треск кости, который был в результате повреждения конечности;</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;\">покраснение кожи в области повреждения, кровоизлияние;</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 пациент может ходить после травмы, то у него появляется характерная прихрамывающая походка.</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\"> </p>",
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"lead": "Хромота - это деформация походки, возникающая под влиянием сильной схваткообразной боли при ходьбе. Появляется желание не нагружать больную ногу и перенести вес на здоровую. В спокойном состоянии нарушение исчезает. Возникает хромота вследствие чрезмерной усталости, когда человек много и тяжело работает. Как правило, она проходит после небольшого отдыха.\r\n\r\nНо, если дефект живет в вами на протяжении длительного времени, пора задуматься. Хромота может быть связана с нарушениями нервной, эндокринной, сердечно-сосудистой системы, заболеваний опорно-двигательного аппарата. Нередко дефект связан с недолеченной травмой. Осложнения после травмирования проявляются намного позже.",
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"code": "H65",
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"lead": "Нарушение здоровья, относящееся к группе болезни среднего уха и сосцевидного отростка",
"description": " Это невоспалительное заболевание среднего уха, симптомами которого являются скопление жидкости в тимпанальной полости, снижение слуха, отсутствие болевого синдрома, сохранность барабанной перепонки. \r\n",
"etiology": "<p>Основная причина: дисфункция евстахиевой трубы. Факторы, способствующие развитию негнойного среднего отита: евстахеит (воспаление слуховой трубы), рубцовые изменения в области глоточного отверстия слуховой трубы, аденоиды, хоанальный полип, острый риносинусит, юношеская ангиофиброма, смещенная носовая перегородка с нарушением функции дыхания, гипертрофия нижних носовых раковин<br /><br /></p>",
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"diagnostics": "<p>Основные диагностические мероприятия включают в себя:</p>\r\n<p> - Консультация врача-оториноларинголога.</p>\r\n<p> - Исследование слуха шепотной и разговорной речью.</p>\r\n<p>- Камертональные пробы.</p>\r\n<p>-Тимпанометрия.</p>\r\n<p>-Тональная аудиометрия.<br /><br /></p>",
"treatment": "<p>Лечение назначается только после подтверждения диагноза врачом-специалистом.</p>\r\n<p>Обычно применяют:</p>\r\n<p>Санация верхних дыхательных путей. Самопродувание, продувание слуховых труб по Политцеру. Пневмомассаж, вибромассаж барабанной перепонки. Катетеризация слуховой трубы. Физиолечение. Антибиотикотерапия. Антигистаминные средства. Сосудосуживающие капли в нос. Ушные капли. При неэффективности медикаментозного лечения показано хирургическое (миринготомия, тимпаностомия с введением вентиляционной трубки, тимпаностомия).<br /><br /></p>",
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}
]
}